Study Says HIV Care Dropped in Face of Ebola Outbreak

The Ebola virus epidemic in West Africa led to a decline in the number of people seeking general outpatient services and as a result caused a drop in HIV testing and enrollment of new patients who are HIV positive, a new study suggests.

About 300,000 people live in the Macenta district in Guinea, one of the areas in West Africa hardest hit by the Ebola outbreak. The area recorded a cumulative incidence of 745 cases at the end of last year and a monthly incidence that peaked at 79 cases per 100,000.

The study assessed the impact of the ongoing epidemic on general HIV care in the Macenta district in south-east Guinea. It was conducted by the Centre Medical de Macenta, a public- private partnership between the Guinea Ministry of Health and the nongovernmental organization Mission Philafricaine, which offers primary care and runs the only HIV treatment center in the district.

Researchers collected and analyzed prospective hospital data and linked it to Ebola surveillance data. They compared program indicators between 2013 and 2014 and focused on the epidemic period from August to December, looking at use of hospital services and HIV services for new patients and for those already in care.

An abstract of the study was presented at the Conference of Retroviral and Opportunistic Infections held this week in Seattle. Results indicate that there was no change in the availability of hospital services. But fear of Ebola apparently kept many people away.

Analysis of the data showed visits and testing related to HIV hovered at 50% less than the year before. Specifically, HIV tests dropped by 46% and the number of patients newly diagnosed with HIV by 53%, and there was a 47% drop in HIV care enrollment, according to the study abstract.

Furthermore, visits to outpatient clinics for primary care dropped by 40%. Researchers also discovered that newly diagnosed cases of tuberculosis dropped 53% while out of pocket patient spending fell 43%.

In contrast, the data revealed that antiretroviral drugs actually increased by 26% in 2014 from the previous year.

Of the 185 newly enrolled patients, there were about 18% “lost to follow-up” at six months during the epidemic period, according to the abstract. Among 60 hospital employees in 2014, one person died from what were considered Ebola-related causes.

The authors of the study concluded that even though there was no change in the services offered, the Ebola epidemic prompted a major drop in attendance of general outpatient services and thus in HIV testing and enrollment of new HIV positive patients. However, HIV care was sustained for those patients who were already receiving it.