Did the 2014 Ebola outbreak in Liberia affect HIV testing, linkage to care and ART initiation?

Jacobs, G; Bhat, Prashant; Owiti, Philip; Edwards, Jeffrey K.; Tweya, Hannock; Najjemba, Robinah

doi:10.5588/pha.16.0101

Cited by 14 publications

(16 citation statements)

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“…For instance, gendered roles as family caregivers and front-line healthcare workers may elevate women's exposure to COVID-19 [41], requiring a genderbased analysis of social and health impacts of public health measures such as quarantine. Past pandemics such as Ebola reduced women's access to maternal and child health services [42], abortion [43], and reduced uptake of HIV services [44]. Social disparities are associated with health disparities.…”

Section: Tensions Between Stigma Mitigation and Covid-19 Public Healtmentioning

confidence: 99%

How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research

2020

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We are not being invaded. The body is not a battlefield. The ill are neither unavoidable casualties nor the enemy. We-medicine, society-are not authorized to fight back by any means whatever. -Sontag (1 p. 180) Sontag's quotation above from 'AIDS and its metaphors' [1] reminds us to expose, and disengage from, constructions of illness that propagate fear. We are called to address the fear of COVID-19 by correcting misinformation [2,3]. While misinformation is indeed a driver of fear and stigma, other underlying facilitators produce stigma [4,5] and need to be considered in stigma mitigation. HIV research and an understanding of the historical construction of illness can be leveraged to mitigate COVID-19 stigma. COVID-19 public health responses-essential for prevention and containment [6,7]-also have the potential to exacerbate stigma [8]. We outline four tensions between COVID-19 containment and stigma mitigation, and offer possible ways forward.

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Section: Tensions Between Stigma Mitigation and Covid-19 Public Healtmentioning

confidence: 99%

How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research

2020

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“…Through restrictions in travel, "no-touch" policies and community fear of health facilities, the ability of the national TB programmes in these countries to diagnose TB and continue with HIV testing of TB patients was adversely affected, and, in the case of Liberia, treatment success rates in TB patients declined [6,7]. HIV testing capabilities for the general population decreased in both countries, although access to antiretroviral therapy (ART) was maintained [8,9]. Early on in the COVID-19 pandemic, The Stop TB Partnership and WHO issued guidance about how people with TB could protect themselves and how national TB programmes might adapt to the COVID-19 pandemic and national lockdowns [10,11].…”

Section: Introductionmentioning

confidence: 99%

Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya

Mbithi¹,

Thekkur

Chakaya

et al. 2021

TropicalMed

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There was concern that the COVID-19 pandemic would adversely affect TB and HIV programme services in Kenya. We set up real-time monthly surveillance of TB and HIV activities in 18 health facilities in Nairobi so that interventions could be implemented to counteract anticipated declining trends. Aggregate data were collected and reported monthly to programme heads during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data collected during the pre-COVID period (March 2019–February 2020). During the COVID-19 period, there was an overall decrease in people with presumptive pulmonary TB (31.2%), diagnosed and registered with TB (28.0%) and in those tested for HIV (50.5%). Interventions to improve TB case detection and HIV testing were implemented from August 2020 and were associated with improvements in all parameters during the second six months of the COVID-19 period. During the COVID-19 period, there were small increases in TB treatment success (65.0% to 67.0%) and referral of HIV-positive persons to antiretroviral therapy (91.2% to 92.9%): this was more apparent in the second six months after interventions were implemented. Programmatic interventions were associated with improved case detection and treatment outcomes during the COVID-19 period, suggesting that monthly real-time surveillance is useful during unprecedented events.

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“…Analyses using routine health information system (RHIS) data originating from Guinea and Sierra Leone have recently chronicled the effect of the EVD epidemic on the delivery of public-sector care for maternal, child, and reproductive health services, showing dramatic decreases during the Ebola outbreak (on the order of 50% declines) and sustained low levels not suggesting recovery [ 3 – 5 ]. Previous descriptive studies using RHIS data from Liberia have shown decreases in maternal and child health (MCH) indicators [ 6 , 7 ], malaria treatment [ 8 ], HIV testing [ 9 ], and tuberculosis diagnoses [ 10 ] during the EVD outbreak. Others have estimated that EVD-related disruptions in treating malaria alone will contribute to significantly more excess deaths than direct EVD-related mortality [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

et al. 2018

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BackgroundThe aim of this study is to estimate the immediate and lasting effects of the 2014–2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data.Methods and findingsWe analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: −77.9%, −56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: −69.0%, −53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: −45.8%, −24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: −47.6%, −29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of −776,110 clinic visits (95% CI: −1,480,896, −101,357, p = 0.030); −24,449 bacille Calmette–Guérin vaccinations (95% CI: −45,947, −2,020, p = 0.032); −9,129 measles vaccinations (95% CI: −12,312, −5,659, p < 0.001); −17,191 postnatal care (PNC) visits within 6 weeks of birth (95% CI: −28,344, −5,775, p = 0.002); and −101,857 ACT malaria treatments (95% CI: −205,839, −2,139, p = 0.044) due to the EVD outbreak. Other outputs showed statistically significant cumulative losses only through December 2014, including losses of −12,941 first pentavalent vaccinations (95% CI: −20,309, −5,527, p = 0.002); −5,122 institutional births (95% CI: −8,767, −1,234, p = 0.003); and −45,024 acute respiratory infections treated (95% CI: −66,185, −24,019, p < 0.001). Compared to pre-EVD forecasted trends, medroxyprogesterone acetate doses and first ANC visits did not show statistically significant net losses. ACT treatment for malaria was the only indicator with an estimated net increase in system outputs through December 2016, showing an excess of +78,583 outputs (95% CI: −309,417, +450,661, p = 0.634) compared to pre-EVD forecasted trends, although this increase was not statistically significant. However, comparing December 2013 to December 2017, ACT malaria cases h...

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Did the 2014 Ebola outbreak in Liberia affect HIV testing, linkage to care and ART initiation?

Cited by 14 publications

References 13 publications

How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research

How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research

Assessing the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Selected Health Facilities in Nairobi, Kenya

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

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