The infectious disease burden among war related internally displaced people in the Lviv region of Ukraine

Introduction Armed conflicts exacerbate the spread of infectious diseases. We assessed the impact of the 2022 armed conflict in Ukraine on common sexually, bloodborne, and respiratory-transmitted infectious diseases in internally displaced people (IDP) in Ukraine. Methods A cross-sectional study (#aware.id) was conducted in Lviv, Ukraine, from 3 May 2023 to 24 June 2024, including IDP seeking care for HIV, hepatitis B and C, COVID-19, tuberculosis, and sexually transmitted infections. After medical screening to evaluate disease risk, we used rapid point-of-care tests followed by confirmatory standard of care testing. The main endpoints were the infectious disease case positivity rate in IDP compared to a local at-risk population, the association with war related risk factors including shelter use and experienced violence, and linkage to care. Results Among 695 enrolled participants (250 IDP and 445 locals), the median age was 37 years (IQR 30-45) and 58.7% were women. Both groups disclosed a high HIV and viral hepatitis disease risk. Among IDP, rates of HIV (4.8% in IDP vs. 7.1% in local at-risk population), hepatitis C (33.9% vs. 40.0%) and syphilis (4.7% vs. 2.7%) were comparable with the local at-risk controls (all p>0.05), while the hepatitis B rate was lower in IDP (6.3% vs. 26.9%, p<0.01). COVID-19, tuberculosis, chlamydia, and gonorrhea were infrequent and comparable (all p>0.05). Despite higher war-related risk factors, we found no clear association with infectious disease burden in IDP disclosing these factors. All those diagnosed were linked to care within 4 weeks. Conclusions The undiagnosed infectious disease burden in IDP was high and comparable to a high- risk local population.