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VIENNA -- After 20 years of battling an epidemic of HIV and hepatitis fueled by injection drug use, Tetiana Deshko, PhD, woke up February 24, 2022, to a whole new challenge as director of the Kyiv-based Alliance for Public Health, Ukraine -- providing services to a country torn apart by invading Russian forces and bombers.

Instead of heading to cities in eastern Ukraine as usual to treat the some 5% of the population there with hepatitis infections, she now had to lead treatment efforts amid skies full of rockets in one area while many of her patients scattered along with the some 18 million Ukrainians seeking shelter in the western part of the country or across borders to Poland and many other nations in the region.

"The Russian invasion has brought enormous challenges to the Ukrainian health system because war puts the most vulnerable at vastly more risk," said Deshko, in discussing the health consequences of the war during a press conference at the annual meeting of the European Association for the Study of the Liver.

"Ukraine has succeeded in maintaining core health services in large part due to the selfless commitment of civil society. We fight for our people and our communities, and our victory will be our prize," she said.

Press conference moderator, Thomas Berg, MD, head of hepatology at the University of Leipzig, Germany, said, "What you are doing to keep patients healthy in your country is really incredible, especially how you try to sustain this situation, even under these circumstances of war."

Deshko described how, over the past 14 months, her healthcare non-governmental organization has learned -- sometimes the hard way -- how to get medical and humanitarian aid to those who fled and to those who couldn't flee the frontline areas of Ukraine.

"We started our work in 2000, reaching out to bring medical aid to individuals in Ukraine who were struggling with HIV, hepatitis, and tuberculosis. And through help from the Global Fund, we were able to develop a successful system to reach most of the people infected with these diseases," she told MedPage Today. "Eventually, we were able to turn the program over to the Ukrainian government."

When Russian forces crossed into Ukraine, supposedly in an attempt to overthrow the government of Volodymyr Zelenskyy in a few days, Deshko and her colleagues found they had a new goal -- helping people caught in the fog of war. "Early on, a group of medical staff borrowed one of our vans and headed to the front lines, but that van was struck by a rocket, killing everyone aboard," she said. "We learned a bitter lesson."

Now, she said, "we only go into areas with the co-ordination of Ukraine military forces. The Alliance has been working close to the front lines in Kharkiv, in liberated Kherson, and now in the Zaporizhzhia region as Russian forces are pushed back."

Over their medical garb, Alliance staff members pull bullet-proof vests over their chests, don metal helmets on their assignments, and take along landmine-detecting equipment as they try to reach people at the heart of the fighting, usually those too ill, too frail, too poor, or too alone to trek to safer areas.

"We started to educate people from the front line," she said. "We started to deliver medications to people who could not access them anymore. We started to organize shelters in caravans. We are preparing for a cold winter, buying electric heaters when our electric grid was destroyed, or buying wood to keep our communities and our patients warm."

"We have to be inventive to [match] the incredible movement of people within Ukraine and outside of Ukraine," Deshko said. "We organized an online chatbot but with a group of 24/7 consultants to help people do their treatment for HIV and for hepatitis."

When funding would permit, Deshko and the Alliance would supply a minibus with doctors, nurses, and social workers and go into areas that the army considered safe enough. "First you see no one there, and then people start coming out of the houses" -- often elderly people or young people who say that they hadn't seen any medical personnel over the last 6 months or so.

"They had very basic needs," she said. "We had to learn how to establish places that were safe -- usually underground -- for treating the people, we had to make sure they could reach these places and to get medical and humanitarian aid to them. We no longer focused on HIV and hepatitis and tuberculosis treatment, but any medical needs."

"You have to arrange care for immobile people who just cannot move, and their carers are also tied to them. They cannot leave their family member and just go away," she explained. "You have to protect them against shelling, too. Sometimes you have to equip shelters because they cannot stay in their house."

She recalls meeting one elderly women in a frontline village, talking to her and giving her food. Then, Deshko said, "We came back a few months later, and her house had been destroyed and she had died there."

But Deshko said the Alliance continues to do its primary job of getting treatment to HIV, hepatitis, and tuberculosis patients in the rest of Ukraine, with its job made more difficult by mass movement of people. "About 15 million people in Ukraine have been displaced by this war," she said. "In places like Lviv where we have 100 patients, almost overnight we had to care for 600 patients. The hepatitis epidemic in Ukraine, which preceded the war, is believed to infect 1.3 million people, yet just 100,000 of them were identified and treated before the conflict."

Deshko estimated that the Alliance and government entities had been treating 16,000 to 18,000 patients with hepatitis C before the war. "Now that is reduced to about 5,000 people spread across 14 countries," she said. "There are not enough medications, and there are structural barriers. Some of the facilities are not available anymore, many of these facilities in Ukraine have been either destroyed or damaged by Russian bombing."

She said that electronic medical records and cross-border co-operation has allowed many of the HIV and hepatitis C patients to receive treatment in western Ukraine and in countries like Poland and Germany.

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