{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T04:00:48Z","timestamp":1771646448843,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Armed conflict in Tigray, Ethiopia, disrupted healthcare, and heightened risks for people with advanced HIV disease (AHD) including serious infections like cryptococcal meningitis (CM). This study described healthcare providers' experiences before, during, and after the conflict, focusing on vulnerabilities in HIV and CM services, infrastructure, and supply availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study was conducted at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia. Healthcare professionals were purposively sampled across outpatient and inpatient settings. Semistructured interviews explored care delivery, resource challenges, and professional experiences across preconflict, conflict, and postconflict phases. Transcripts underwent inductive thematic analysis, with iterative coding and team consensus to identify key themes reflecting participants' experiences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Interviews with 13 healthcare professionals highlighted 4 main findings: (1) the conflict disrupted HIV and CM services, causing drug shortages, treatment interruptions, and preventable suffering; (2) providers faced significant emotional and moral distress while delivering care in conflict settings; (3) essential medications, diagnostic tools, and standardized supplies for CM care were largely unavailable at all phases of conflict; and (4) gaps in training and limited adherence to CM guidelines hindered effective patient management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study described frontline providers' experiences of HIV and CM care before, during, and after the northern Ethiopian conflict. Findings revealed disrupted services, severe shortages of essential medications and diagnostics, provider moral distress, and limited adherence to CM guidelines. Highlighting the urgent need to rebuild healthcare infrastructure, secure uninterrupted HIV and CM treatment, strengthen evidence-based training, and provide sustained psychosocial and professional support for healthcare providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag058","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:47:36Z","timestamp":1770900456000},"source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Conflict on Medical Services for People Living With Advanced HIV Disease and Cryptococcal Meningitis in Ethiopia's Tigray Region: A Qualitative Study of Healthcare Providers"],"prefix":"10.1093","volume":"13","author":[{"given":"Temesgen","family":"Nurye","sequence":"first","affiliation":[{"name":"Addis Ababa University Department of Neurology, , Addis Ababa ,","place":["Ethiopia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6472-5869","authenticated-orcid":false,"given":"Mengistu","family":"Hagazi","sequence":"additional","affiliation":[{"name":"Mekelle University College of Health Sciences School of Public Health, , Mekelle ,","place":["Ethiopia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6006-3909","authenticated-orcid":false,"given":"Gerome B","family":"Vallejos","sequence":"additional","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, NewYork Presbyterian Hospital , New York, New York ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5714-7212","authenticated-orcid":false,"given":"Carla Y","family":"Kim","sequence":"additional","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, NewYork Presbyterian Hospital , New York, New York ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8435-0903","authenticated-orcid":false,"given":"Sennay","family":"Gebremariam","sequence":"additional","affiliation":[{"name":"Mekelle University College of Health Sciences School of Public Health, , Mekelle ,","place":["Ethiopia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraha","family":"Gebreegziabher","sequence":"additional","affiliation":[{"name":"Mekelle University College of Health Sciences School of Public Health, , Mekelle ,","place":["Ethiopia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kibrom","family":"Gebreselasie","sequence":"additional","affiliation":[{"name":"Mekelle University College of Health Sciences School of Public Health, , Mekelle ,","place":["Ethiopia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-9734","authenticated-orcid":false,"given":"Kathryn B","family":"Holroyd","sequence":"additional","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, NewYork Presbyterian Hospital , New York, New York ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran T","family":"Thakur","sequence":"additional","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, NewYork Presbyterian Hospital , New York, New York ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"2026022022130951500_ofag058-B1","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1016\/S2214-109X(24)00538-2","article-title":"Prevalence of advanced HIV disease in sub-Saharan Africa: a multi-country analysis of nationally representative household surveys","volume":"13","author":"Stelzle","year":"2025","journal-title":"Lancet Glob Health"},{"key":"2026022022130951500_ofag058-B2","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1473-3099(17)30243-8","article-title":"Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis","volume":"17","author":"Rajasingham","year":"2017","journal-title":"Lancet Infect Dis"},{"key":"2026022022130951500_ofag058-B3","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1186\/s12889-023-16983-z","article-title":"Exploring the health consequences of armed conflict: the perspective of Northeast Ethiopia, 2022: a qualitative study","volume":"23","author":"Arage","year":"2023","journal-title":"BMC Public Health"},{"key":"2026022022130951500_ofag058-B4","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s13031-025-00685-x","article-title":"Healthcare accessibility in Yemen\u2019s conflict zones: comprehensive review focused on strategies and solutions","volume":"19","author":"Salem","year":"2025","journal-title":"Confl Health"},{"key":"2026022022130951500_ofag058-B5","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s13031-023-00568-z","article-title":"The impact of conflict on infectious disease: a systematic literature review","volume":"18","author":"Marou","year":"2024","journal-title":"Confl Health"},{"key":"2026022022130951500_ofag058-B6","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13031-025-00667-z","article-title":"Health care without medicine: the impact of war on Sudan\u2019s pharmaceutical manufacturing and supply","volume":"19","author":"Verjee","year":"2025","journal-title":"Confl Health"},{"key":"2026022022130951500_ofag058-B7","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1016\/S0140-6736(25)00547-1","article-title":"Sudan\u2019s war and the burden of HIV: a call for urgent intervention","volume":"405","author":"Al Zamel","year":"2025","journal-title":"The Lancet"},{"key":"2026022022130951500_ofag058-B8","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1136\/sextrans-2017-053438","article-title":"HIV\/AIDS in Syria and the response of the National AIDS Program during the war","volume":"94","author":"Khamis","year":"2018","journal-title":"Sex Transm Infect"},{"key":"2026022022130951500_ofag058-B9","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1186\/1471-2458-14-628","article-title":"The HIV epidemic and prevention response in Tigrai, Ethiopia: a synthesis at sub-national level","volume":"14","author":"Barnabas","year":"2014","journal-title":"BMC Public Health"},{"key":"2026022022130951500_ofag058-B10","doi-asserted-by":"crossref","first-page":"6434","DOI":"10.1038\/s41598-025-90848-w","article-title":"Outcome of HIV patients on ART during the war and siege in a tertiary hospital in Northern Ethiopia: a cross-sectional study","volume":"15","author":"Weledegebriel","year":"2025","journal-title":"Sci Rep"},{"key":"2026022022130951500_ofag058-B11","author":"The Guardian"},{"key":"2026022022130951500_ofag058-B12","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1016\/S2352-3018(25)00014-1","article-title":"Disruption of HIV care during conflict in Sudan: a growing crisis","volume":"12","author":"Hassan","year":"2025","journal-title":"Lancet HIV"},{"key":"2026022022130951500_ofag058-B13","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1016\/S0140-6736(17)31328-4","article-title":"Attacks against health care in Syria, 2015\u201316: results from a real-time reporting tool","volume":"390","author":"Elamein","year":"2017","journal-title":"The Lancet"},{"key":"2026022022130951500_ofag058-B14","doi-asserted-by":"crossref","first-page":"7306","DOI":"10.34172\/ijhpm.2023.7306","article-title":"Human resources for health in conflict affected settings: a scoping review of primary peer reviewed publications 2016\u20132022","volume":"12","author":"Onvlee","year":"2023","journal-title":"Int J Health Policy Manag"},{"key":"2026022022130951500_ofag058-B15","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1186\/s12879-025-11113-z","article-title":"The wartime prevalence of HIV, HBV, and reported STI-related syndromes among tested individuals in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia","volume":"25","author":"Shfare","year":"2025","journal-title":"BMC Infect Dis"},{"key":"2026022022130951500_ofag058-B16","doi-asserted-by":"crossref","first-page":"779778","DOI":"10.3389\/fpubh.2022.779778","article-title":"The impact of armed conflict on the prevalence and transmission dynamics of HIV infection in Libya","volume":"10","author":"Daw","year":"2022","journal-title":"Front Public Health"},{"key":"2026022022130951500_ofag058-B17","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1073\/pnas.1701447115","article-title":"Molecular epidemiology reveals the role of war in the spread of HIV in Ukraine","volume":"115","author":"Vasylyeva","year":"2018","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2026022022130951500_ofag058-B18","doi-asserted-by":"crossref","first-page":"133","DOI":"10.7705\/biomedica.7250","article-title":"Impact of the armed conflict on victims and support workers\u2019 mental health in Soacha, Colombia","volume":"45","author":"Pi\u00f1eros","year":"2025","journal-title":"Biomed"},{"key":"2026022022130951500_ofag058-B19","doi-asserted-by":"publisher","first-page":"122","DOI":"10.30574\/gscarr.2023.17.1.0403","article-title":"The effect of armed conflict on public health and strengthening of healthcare system during and post -armed conflict in Sudan","volume":"17","author":"Elsharief","year":"2023","journal-title":"GSC Adv Res Rev"},{"key":"2026022022130951500_ofag058-B20","doi-asserted-by":"publisher","first-page":"79","DOI":"10.5070\/BS326157104","article-title":"The effect of conflict on healthcare workers in Syria: results of a qualitative survey","volume":"26","author":"Abdelrahman","year":"2021","journal-title":"BSJ"},{"key":"2026022022130951500_ofag058-B21","doi-asserted-by":"crossref","first-page":"103233","DOI":"10.1016\/j.eclinm.2025.103233","article-title":"The impact of the PEPFAR funding freeze on HIV deaths and infections: a mathematical modelling study of seven countries in sub-Saharan Africa","volume":"83","author":"Hontelez","year":"2025","journal-title":"eClinicalMedicine"},{"key":"2026022022130951500_ofag058-B22","doi-asserted-by":"crossref","first-page":"e0287862","DOI":"10.1371\/journal.pone.0287862","article-title":"Differentiated service delivery models for antiretroviral treatment refills in Northern Nigeria: experiences of people living with HIV and health care providers-A qualitative study","volume":"18","author":"Semo","year":"2023","journal-title":"PLoS One"},{"key":"2026022022130951500_ofag058-B23","doi-asserted-by":"crossref","first-page":"e26113","DOI":"10.1002\/jia2.26113","article-title":"Person-centred, integrated non-communicable disease and HIV decentralized drug distribution in Eswatini and South Africa: outcomes and challenges","volume":"26","author":"Goldstein","year":"2023","journal-title":"J Int AIDS Soc"},{"key":"2026022022130951500_ofag058-B24","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/QAD.0000000000002737","article-title":"Community-based delivery of HIV treatment in Zambia: costs and outcomes","volume":"35","author":"Nichols","year":"2021","journal-title":"AIDS"},{"key":"2026022022130951500_ofag058-B25","first-page":"100847","article-title":"Continuity of care during severe civil unrest with a model of community-based HIV care: a retrospective cohort study from Haiti","volume":"37","author":"Joseph","year":"2024","journal-title":"Lancet Reg Health Am"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag058\/66890742\/ofag058.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/2\/ofag058\/66890742\/ofag058.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/2\/ofag058\/66890742\/ofag058.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T03:13:19Z","timestamp":1771643599000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag058\/8482681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag058","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2026,2]]},"article-number":"ofag058"}}