Lab on wheels tracks HIV spread in war-torn Ukraine

The invasion of Ukraine crippled health services, allowing diseases such as HIV to spread unchecked. The rate of contagion has been difficult to assess. But now, using a van equipped with portable research equipment, virologist Ganna (Anna) Kovalenko is investigating the hidden threat of HIV in this war-torn country.

HIV has been spreading in Ukraine since the 1990s, primarily through intravenous drug use but also through sexual activity, says Kovalenko, of the University of California, Irvine. The Russian invasion of Crimea in 2014 and the widened seat from 2022 have exacerbated the problem by reducing access to tests, treatments and preventive measuressuch as needle exchange programs.

Even when tests are available, clinicians do not systematically sequence virus genomes look for mutations of concern, such as those that lead to drug resistance. This is partly because sequencing is normally tied to laboratories, often located far from virus hotspots.

This is where a project called the ARTIC network comes in. It aims to bring sequencing tools to remote or inaccessible places, such as during the 2014 Ebola outbreaks in West Africa. Kovalenko, who is part of the network, wondered whether portable sequencing tools might prove useful in other emergency scenarios, such as mapping the spread of HIV across Ukraine.

So she and her team decided to build a lab in a van.

In a test run in August 2024, Kovalenko and his colleagues traveled to Lviv, a relatively safe hub in western Ukraine for displaced people who have migrated away from the front lines. “We worked during the day. Most of the missile attacks took place at night,” she says. During three days in the van, many of the local health professionals she met along the way shared their frustrations with the conflict.

“They describe situations where missile attacks started during the day while they were providing care and they had to respond immediately, leaving everything behind and leaving as quickly as possible,” she says. Health care workers could not escape without parting with their laboratory equipment.

Previously, only fixed clinics were used to monitor the spread of HIV. Physician Casper Rokx, for example, opened fixed clinics in Lviv to provide HIV care from 2023 to 2025. “We did not reach hard-to-reach populations, at least not as effectively as we wanted,” says Rokx, an HIV specialist at Erasmus MC in Rotterdam, the Netherlands. On the other hand, “the vans can just go to where the people are.”

During their test drive, Kovalenko’s team took blood samples from 20 HIV-positive people. Kovalenko assumed that they wouldn’t find anything interesting with such a small group of participants, only hoping to demonstrate that the van had promise. Instead, researchers discovered a strain of HIV which occurred among displaced people in Lviv after the outbreak of the expanded war, the team reported in the newspaper AIDS.

“This gives us direct evidence that war and displacement are changing the way HIV spreads,” says Kovalenko. By comparing the genome of this strain to other HIV genomes sequenced in 2020, the researchers estimate, based on how quickly the virus mutates, that the new variety appeared after the expansion of the Russian invasion in 2022.

They also discovered a mutation in a gene in the virus that made it resistant to a rescue antiretroviral drug, raising alarms. If the team were to sequence HIV in more displaced people in the future, they could discover additional resistance mutations to first-line drugs. “It’s not as hypothetical as we initially thought,” Rokx says. Scientists have found that resistance to first-line HIV drugs is a growing problem elsewhere, like South Africahe notes.

In the future, Kovalenko would like to explore other applications of his mobile laboratory. “Antimicrobial resistance “It’s one of the most pressing problems on the front lines,” where soldiers often develop infected wounds, she says, so sequencing bacterial genomes could help clinicians prescribe appropriate antibiotics. Kovalenko and Rokx note that tuberculosis is another growing burden in Ukraine, and the bacteria causing this disease are often resistant to multiple drugs.

War has provided a smokescreen for HIV to spread and mutate, but this van could help researchers cut through that fog. “I think what they did well was bring deep sequencing and advanced laboratory techniques to a population in need,” Rokx says.