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
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