Attendance to HIV services at Guinea clinic declines sharply during Ebola epidemic
SEATTLE — There was a significant drop in attendance to outpatient HIV services provided in Macenta, Forest Guinea, as a result of the Ebola epidemic, according to data presented at CROI 2015.
The Macenta district was one of the areas hardest hit by the epidemic in West Africa, said David Leuenberger, MD, of Mission Philafricaine in Conakry, Guinea. At of the end of 2014, there were 745 cumulative Ebola cases in the district, for a rate of 250 cases per 100,000, which was 10 times that of the entire country.
“Many health care sites were affected by Ebola, in the sense that they have offered fewer services to focus on Ebola care,” Leuenberger told Infectious Disease News. “In our hospital, we managed to continue services, unlike many other hospitals. Despite that, we saw a massive drop in attendance, which was one surprise. Our hospital did not offer Ebola services, so there was no reason for patients to be afraid of contracting Ebola at our center. It’s not clear to me why they didn’t come for services.”
Leuenberger and colleagues analyzed prospective data collected from the Centre Médical de Macenta and linked the data with Ebola surveillance data. They compared services used in 2013 with those in 2014, with a focus on the epidemic period of August to December. The researchers examined overall hospital use, HIV services for new patients and HIV services for patients already in care.
There was no change in the services provided over the epidemic. Although there was a 26% increase in the number of antiretroviral drugs dispensed in 2014 compared with 2013, there was a 40% decline in outpatient services provided during the August-December Ebola epidemic period. There also was a 43% drop in out-of-pocket money spent on service fees and medications, a 53% drop in the number of tuberculosis cases diagnosed, a 46% decline in the number of HIV tests conducted and a 47% drop in enrollment into HIV care.
There was one exception: people already enrolled in HIV care at the hospital mostly continued to attend for their services, Leuenberger said.
“That was the positive surprise,” Leuenberger said. “The impact on those patients was much less than we had feared. It seems that trust is a major issue. New patients, who didn’t know us, were afraid to come, whereas those who had been in our care for some time managed to overcome the obstacles and present for care.”
Leuenberger said there were three confirmed Ebola-related deaths among the center’s patients with HIV. But among the remaining patients who were lost to follow-up or died, it is unknown if they were affected by Ebola.
“The main message is that Ebola has been a huge catastrophe in itself, but there has been a hidden catastrophe behind the actual Ebola,” Leuenberger said. “The overall weakness of the health care system has been a major factor in the Ebola epidemic, but it has been further weakened as a result of the epidemic. We are afraid that post-Ebola, many services — HIV, tuberculosis, malaria, women’s health, child health, etc. — will be affected in the long-term as a consequence. We hope that there will be global effort to mitigate those effects after Ebola has left the headlines.” – by Emily Shafer
Leuenberger D. Abstract 103LB. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 23-26, 2015; Seattle.
Disclosure: Leuenberger reports no relevant financial disclosures.