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Access to HIV Care in Health Districts Affected by Ebola Epidemic in Sierra Leone
Jacques D. Ndawinz1; Kenneth Katumba2; Victor Kamara3; Wogba Kamara3; Lamin Bangura4; Victoria Kamara4; Umu N. Nabieu4; Etienne Guillard1
1Solthis NGO, Paris, France;2Solthis NGO, Conakry, Guinea;3Natl AIDS Secretariat, Freetown, Sierra Leone;4Natl AIDS/VIH Control Prog, Freetown, Sierra Leone
The frequency of deaths caused by the current EVD epidemic among health-care workers severely disrupted supply and quality of routine health activities in West Africa. In addition, cultural beliefs and the fear of being contaminated by the EVD made patients reluctant to seek treatment from health facilities, particularly in areas where EVD cases were diagnosed. In Sierra-Leone, the effect of the current EVD epidemic on the continuity of HIV care has not yet been documented.
The National AIDS Control Programme (NACP) is the specialized programme in charge of monitoring and evaluation of HIV programmes in Sierra Leone. NACP manages a nationwide database including the number of ART patients ‘currently on care’. During 2014, 126 HIV facilities reported data to NACP. Missing data for HIV facilities that were still functional during the period was imputed using the multiple imputation method. To assess the impact of the EVD epidemic on the continuity of HIV care during 2014, we first calculated the rate of change (ROC) between successive months of the numbers of ART-patients ‘currently in care’. Secondly, we calculated the proportion of the number of months (PNM) in which the ROC was negative during the post-outbreak period. PNM with negative ROC was used to make comparisons between and within health districts. All analysis was made using Stata11.
During the year 2014, the number of ART-patients ‘currently in care’ increased from 10,300 in January to 11,750 in July followed by a slow decline until October (11,400), and a slow increase until December (11,660). The period of July to October corresponds to the peak of the EVD epidemic. The PNM with negative ROC varied within facilities from 0% to 80% and the median PNM with negative ROC was 33% (interquartile range: 17%-50%). The highest PNM with negative ROC was found in 8 HIV facilities located principally in Port Loko, Tonkili, Western rural and Kono, the most affected Ebola health districts. The highest median PNM with negative ROC within health district was at Port Loko health district.
Our results support the hypothesis that the decline of ART-patients that were ‘currently in care’ during 2014 was attributable to the EVD epidemic in Sierra Leone. The impact of Ebola on the continuity of HIV care was variable between and within health districts. This study will contribute to improve future epidemics preparedness.