COVID-19 preparedness at health facilities and community service points serving people living with HIV in Sierra Leone

Abstract

After a decade of civil war and the 2014–2016 West African Ebola outbreak, Sierra Leone now faces the COVID-19 pandemic with a fragile health system. As was demonstrated during Ebola, preparedness is key to limiting a health crisis’ spread and impact on health systems and ensuring continued care for vulnerable populations including people living with HIV (PLHIV). To assess COVID-19 preparedness and inform interventions to ensure continuity of HIV services at health facilities (HFs) and community service points (CSPs), we conducted site readiness assessments in Freetown, the epicenter of COVID-19 in Sierra Leone. Data were collected at nine high-volume HIV HFs and seven CSPs in April 2020, a month after COVID-19 was declared a pandemic. CSPs comprised three community drop-in centers providing HIV counseling and testing services as well as HIV prevention services (e.g., condoms and lubricants) for key and priority populations and four community-based support groups serving PLHIV. At the time of assessment, CSPs did not provide antiretroviral therapy (ART) but were considered potential sites for expansion of differentiated service delivery (DSD)—a client-centered approach to HIV care—in the context of COVID-19. Overall, 5/9 HFs had trained staff on use of personal protective equipment (PPE) and prevention of COVID-19 transmission. Most had access to masks (5/9) and gloves (7/9) for management of suspected/confirmed COVID-19 cases, and 4/9 HFs had triage procedures for isolation of suspected cases. Conversely, few CSPs had access to masks (2/7) or gloves (2/7) and no staff were trained on PPE use or COVID-19 transmission. 7/9 HFs had adequate ART stock for multi-month dispensing though few had procedures for (3/9) or had trained staff in providing DSD (2/9). Among CSPs where measures were applicable, 2/4 had procedures for DSD, 1/3 had staff trained on DSD and none had adequate ART stock. Identification of gaps in COVID-19 preparedness is a critical step in providing support for infection control and modified service delivery. Findings from this assessment highlight gaps in COVID-19 preparedness measures at sites supporting PLHIV in Sierra Leone and indicate CSPs may require intensive supervision and training to ensure HIV services are uninterrupted while minimizing COVID-19 risk, especially if used as sites to scale up DSD.

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“…Countries have been taking strong preventive measures to reduce and curve the transmission (2)(3)(4). Many health care professionals shifted and health facilities were repurposed into targeted COVID-19 centers to manage patients (5)(6)(7). Evidence showed these measures have led to restrictions of health facilities to the management of emergency medical conditions and chronic diseases care and treatment services (8,9).…”

Using Google Health Trends to investigate COVID-19 incidence in Africa

“…These three countries also ranked within the top 10 when looking at the total number of mobile cellular subscriptions in a country and GDP (Supplementary table 1). On the other hand, Burkina Faso, Sierra Leone, and Sudan are lower-income countries, and have struggled to combat COVID-19 [50, 51, 52]; according to World Bank data, they ranked lower than the top-ranking countries in terms of total number of mobile cellular subscriptions in a country (Supplementary table 1). Furthermore, four out of these six countries had an extremely low percentage of individuals using the Internet (< 20% as of 2017), which may indicate that the way Internet access is currently measured reflects GHT behavior poorly.…”

“…These three countries also ranked within the top 10 when looking at the total number of mobile cellular subscriptions in a country and GDP (Supplementary table 1). On the other hand, Burkina Faso, Sierra Leone, and Sudan are lower-income countries, and have struggled to combat COVID-19 [50,51,52]; according to World Bank data, they ranked lower than the top-ranking countries in terms of total number of mobile cellular subscriptions in a country (Supplementary table 1).…”

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“… 24 Lockdown restrictions, despite successfully managing COVID‐19, were instrumental in preventing many of these countries reaching their 90‐90‐90 targets and further elucidate the negative implications of COVID‐19 on the care for PLHIV. 23 , 25 …”