Background Ebola virus RNA persists in the semen of male Ebola survivors for months to years after the acute infection and male-to-female sexual transmission of the virus is well documented. We investigated whether remdesivir can safely reduce persistence of seminal Ebola virus RNA. Methods We recruited men with persistent seminal Ebola RNA in Liberia and in Guinea. Participants were randomized 1:1 to receive intravenous remdesivir (GS-5734; Gilead Sciences) or matching placebo administered once daily by intravenous infusion over one hour on 5 consecutive days. Stratification was by country and number of positive (1 or 2) pre-enrollment semen tests. The study team was blinded to treatment group allocation and specific liver related lab results. We evaluated the difference in mean assay negativity rate (ANR), i.e., the proportion of negative tests for each participant in each group in the treatment (days 1-28) and follow-up (months 2-6) phases, on an intention-to-treat basis. ClinicalTrials.gov NCT02818582; closed. Results We enrolled 38 men from July 2016 through June 2018. The mean treatment phase ANRs were 85% (sd=24%) and 76% (sd=30%) in the remdesivir and placebo arms, respectively (p=0.270). The mean follow-up phase ANRs were 96% (sd=10%) and 81% (sd=29%) in the remdesivir and placebo arms, respectively (p=0.041). The five-day remdesivir regimen was well-tolerated with no safety concerns. Conclusions In this small trial, remdesivir 100mg/day for five days safely reduced the presence of Ebola virus RNA in the semen of Ebola survivors two to six months after administration. A larger follow up study is necessary to confirm results.

The 5-year Resilient and Responsive Health Systems (RRHS)-Liberia Initiative, funded by PEPFAR via HRSA, launched in 2017 and was designed to support the implementation of Liberia's National Health Workforce Program as a means to improving HIV-related health outcomes. The COVID-19 pandemic, arrived in Liberia just five years after Ebola and during RRHS-Liberia's fourth year, impacted educational programs and threatened the project's continued work. This paper presents the challenges that the COVID-19 pandemic posed to the RRHS partners, as well as adaptations they made to maintain progress towards project goals: 1) contributing to Liberia's 95-95-95 HIV targets via direct service delivery, and 2) building a resilient and responsive health workforce in Liberia via instruction and training. Direct health service impacts included decreased patient volumes and understaffing; adaptations included development of and trainings on safety protocols, provision of telehealth services, and community health worker involvement. Instruction and training impacts included suspension of in-person teaching and learning; adaptations included utilization of multiple online learning and virtual conferencing tools, and increasing clinical didactics in lieu of bedside mentorship. The RRHS team recommends that these adaptations be continued with significant investment in technology, IT support, and training, as well as close coordination among partner institutions. Ultimately, the RRHS Liberia consortium and its partners made significant strides in response to ensuring ongoing education during the pandemic, an experience that will inform continued service delivery, teaching, and learning in Liberia.

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