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.