Rosie Davis – Assistant County Director Ebola Emergency

Field realities and first priorities in responding to Ebola and related HIV issues

Background – Ebola and HIV in Sierra Leone

Ebola

KAMBIA

PORT LOCO

BOMBALI

KOINADUGU

MOYAMBA

BONTHE

PUJEHUN

KENEMA

K ONO

FREETOWN

T ONKOLILI

BO

KAILAHUN 24th May 2014

12,201 cases12th April

3804 deaths12th April

3357 survivors12th April

437 HCW cases1st February

221 HCW deaths1st February

Background – Ebola and HIV in Sierra Leone

HIV

UNAIDS Country Progress Report 2014 and DHS SL 2013

Adult prevalence – increased from 0.9% in 2002 to 1.5% in 2005. Remained constant between the 2008 SLDHS and the 2013 SLDHS at 1.5%

Women are disproportionately infected by the epidemic; prevalence is 1.7% among women and 1.3% among men.

HIV prevalence in urban areas is twice that in rural areas, at 2.3% among adults age 15-49 in urban areas compared with 1.0% in rural areas.

HIV prevalence among pregnant women attending antenatal clinics declined from 4.4% in 2007 to 3.2% in 2010 but is still twice higher than the national prevalence of 1.5%

Concern Worldwide’s Response to Ebola

Programmes designed to focus on prevention at each stage of the

transmission chain and impact mitigation

Water and

sanitation

Community care

facilities IPC at primary

healthcare

facilities

Safe burial

Social mobilisatio

nSupport

to quarrant-

ined househol

d

Initial response activity – raising awareness routes of transmission and prevention strategies

Supported over 80 households in Tonkolili and 3000 individuals

Provided water and sanitation in 8 holding and treatment facilities and a further 10 clinics

Trained over 1500 clinical staff across 205 PHC facilities and continue bi-weekly supervisory visits

Train and support 13 community care centres built to isolate suspected Ebola cases

Manage two cemeteries and 14 burial teams. Our teams have collected over 5500 bodies and buried

>10,000

Concern Worldwide’s Ebola Response – Impact Mitigation

Quarantined HH support – food security

Over 3000 individuals supported with food or NFIs across communities

in Tonkolili District

Psychosocial support for burial teams

168 members from 14 burials teams receiving PSS over 4 month

intervention

Radio education programme

Established over 1,500 small learning groups and has been distributing

nearly 30,000 learning kits and 2,000 radios

Wider Impact of Ebola on Health

The number of antenatal care visits (ANC 4) declined by 27% nationally during the period

from May to September 2014

The number of deliveries in facilities declined by 23% nationally between May and

September 2014.

The number of women coming to health facilities declined by 27% nationally.

The number of children coming to health facilities for the third dose of Penta declined by

21% nationally between May and September 2014.

The number of children under-five treated for malaria declined by 39% between May and

September.

Impact of Ebola on HIV

Clear evidence of reduction in service demand and provision in 2014

PMTCT visits, changes over time (May - Sep 2014)

PMTCT visits May / sep May/ J une J une/ J uly J uly/ aug Aug/ sep

Bombali -16% 1% 1% 5% -21%

Kambia -40% -19% 24% -23% -22%

Koinadugu -30% -12% -1% -22% 3%

Port Loko -45% -18% 24% -37% -14%

Tonkolili -34% -13% 26% -39% -2%

Overall -34% -13% 16% -26% -12%

Kailahun -18% -36% 1% 11% 13%

Kenema -22% -6% -25% 11% 0%

Kono -12% -13% -3% -7% 11%

Overall -19% -16% -14% 6% 6%

Bo 1% -11% 14% 2% -2%

Bonthe -41% -31% -11% -8% 6%

Moyamba -8% -21% 21% -14% 13%

Pujehun 0% -3% -7% 8% 2%

Overall -8% -14% 6% -1% 2%

WA Rural -34% -11% 6% -11% -22%

WA Urban -22% -23% -2% -6% 10%

Overall -26% -19% 1% -8% -1%

National -23% -15% 4% -11% -3%

Impact of Ebola on HIV 2

Januar

y

Febru

ary

Mar

chApril

May

June

July

August

Septe

mber

Octob

er

Novem

ber

Decem

ber0

200

400

600

800

1000

1200

Testing data 2014 in five large Freetown HIV Clinics

Lumley (PMTCT)

Rokupa (HCT)

KHR (HCT)

Military (HCT)

Connaught CC (HCT)

Total all facilties

Total all facil-ties

Lumley (PMTCT)

Rokupa (HCT) KHR (HCT) Military (HCT)0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Testing Data for 2013 and 2014 across four large Freetown HIV

clinics

20132014

Concern Worldwide’s HIV support in Tonkolili

Present in Tonkolili since 2002Mainstreaming HIV across our programmes funded by Irish Aid

Challenging stigma through radio discussions, drama, working with

PLHIVSupport to ‘Wan Fambul’ an HIV peer support group Mobile VCT with accompanying drama

2013 – supported 42 communities with mobile VCT and drama.

7,404 people (3,828F, 3,576 men) attended the drama sensitisation

1,185 women and 711 men voluntarily opted for VCCT

18 people (14F, 4M) were found to be HIV positive

506 clients (372F, 134M) in the district were regularly receiving their ARV drugs each month from the 11 ART centres in Tonkolili

June July August0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Defaulter rates in Tonkolili District 2014

In August almost half of all registered men with HIV and more than one third of registered women with HIV were defaulting

In April, the month before the Ebola outbreak in Sierra Leone, this was only 2%.

Alie Turay and Wam Fambul Coordinator Hanna Gbla. October 2014, photo by Renee Zandvliet

Phone Outreach

One-to-one training on Ebola prevention

Hygiene kit distribution

Outreach distribution of ARVs – 3 month supply

“Fortunately none of our members has been infected with the Ebola virus, but many of them are afraid to go to the hospital for their drugs.”

“They explained to me about chlorine and soap and they showed me how I should wash my hands”

Stigma in Sierra Leone

Stigma is common in Sierra Leone

SL HIV sigma index 2014 showed high rates of perceived stigma among PLHIV, one

representation of this is this that only 36% men and 30% of women disclose their status to

family members

A survey conducted by Concern in Tonkolili District in February 2013 found that only 5.8% of

men and 4.3% of women had accepting attitudes towards people living with HIV and AIDS.

Ebola-related stigma is high  http://youtu.be/iP3zNicttME

PLHIV may face increased stigma with opportunistic infections or general symptoms looking

like Ebola symptoms. This has led to increased chance of isolation at facilities and referral/

Moving Forwards

Rejuvenate VCT

Support to district AIDS council

Conduct outreach VCT with drama

Training for health staff

Internal mainstreamin

g of HIV

Staff attitudes survey

Quarterly staff discussion

Provide support to

PLHIV

Village Savings and Loans Association (VSLA) for support groups for people with HIV training on nutrition and exchange visits among groups.

Challenge stigma

Radio discussions

Reintegration programme for burial team members