September 19, 2016
2 min read

Liberian semen testing program supports male Ebola survivors

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In addition to providing new data on virus RNA clearance, a nationwide semen testing program established last year provided behavioral and safe sex counseling to hundreds of male Liberian Ebola survivors, according to a recently published report.

“In [2015], WHO released interim guidelines recommending that all male survivors, in addition to receiving condoms and sexual risk reduction counseling at discharge from an Ebola treatment unit, be offered semen testing for Ebola virus RNA by [real-time]-PCR 3 months after disease onset, and every month thereafter until two consecutive semen specimens collected at least 1 week apart test negative for Ebola virus RNA,” Lawrence J. Purpura, MD, of the Division of High Consequence Pathogens and Pathology at the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and colleagues wrote.

“Male Ebola survivors should also receive counseling to promote safe sexual practices until their semen twice tests negative. When these recommendations were released, testing of semen was not widely available in Liberia.”

In response to these recommendations, Liberia launched the Men’s Health Screening Program (MHSP) in July 2015. The program was open to all male Ebola survivors aged at least 15 years with proof of survival, and it provided regular semen testing, safe sex counseling, condoms and referrals to health care services if necessary. Participants primarily attended the program at a nearby clinic; those unable to do so received service via a mobile team.

Early data on Ebola virus RNA suggested that the MHSP would only need to operate for 6 months, Purpura and colleagues wrote, and was budgeted accordingly. However, 11% of the 228 participants enrolled at the 6-month mark had produced at least one positive sample, and only four participants had recorded two consecutive negative samples. This inability to approximate the end of the program presented the Liberian Ministry of Health with planning and budgeting challenges, they wrote, although the program is currently funded through 2016.

Aside from funding, the MHSP faced substantial challenges attracting survivors and coordinating staff appropriately. To overcome stigma toward Ebola survivors, the program was not advertised on the radio. Instead, program coordinators reached out to survivors directly or through other participants, although this effort was complicated by difficulties identifying unreached survivors. Swift initiation of the MHSP also hampered efforts to train new mental health counselors, forcing the public health program to instead recruit staff from a Liberian hospital.

Twenty percent of the survivors opted to receive the program’s services through the mobile teams. This strategy offered convenience and privacy, the researchers wrote, and occasionally allowed program staff to offer joint counseling to a survivor’s partner. However, mobile teams were much less efficient than those in the clinic and experienced occasional issues of privacy when other family members also were present.

In spite of these challenges, Purpura and colleagues wrote that approximately 500 male Ebola survivors have been enrolled in the program since its inception. Of these, 80% have graduated from the MHSP, and 95% of these graduates reported they would refer another survivor to the program. In addition, preliminary data collected through the program and reported recently by Moses J. Soka, MD, MHSP director, and colleagues demonstrated that Ebola virus RNA can persist in survivor semen for more than 1 year, with one case persisting after as many as 565 days.

“Hiring and training local staff members can enhance local capacity, creating a pool of trained personnel who can respond in the aftermath of another public health crisis,” Purpura and colleagues wrote. “Lessons learned during the establishment of MHSP in Liberia might inform the planning and implementation of future semen testing programs for other sexually transmissible diseases.” – by Dave Muoio

Disclosure: The researchers report no relevant financial disclosures.