Presentation by Dr. Meba Kagone at "Post-Ebola Survivors - Research and Recovery Lessons from West Africa," a USAID Brown Bag on May 2, 2019 at USAID/Crystal City. Together with NIH/PREVAIL, today’s session focuses on learnings from these programs in relation to survivor care and post-outbreak recovery of health services and health systems. Facilitator: Jeff Sanderson, Team Leader, West Africa Post-Ebola Programs, JSI R&T/APC The Presenters: Dr. Libby Higgs, Global Health Science Advisor for the Division of Clinical Research at NIAID, NIH (confirmed) Dr. Meba Kagone, former Chief of Party for ETP&SS, Guinea, JSI/APC (confirmed) Dr. Rose Macauley, former Chief of Party for ETP&SS, Liberia, JSI/APC (confirmed) Jeff Sanderson (for Dr. Kwame Oneill, former Director of the Program Implementation Unit, Ministry of Health and Sanitation, Sierra Leone) Background: The Ebola Transmission Prevention & Survivor Services (ETP&SS) program included four components; country programs in Guinea, Liberia and Sierra Leone, and a regional program designed to share best practices and lessons learned. ETP&SS assisted these governments to prevent further Ebola transmission, reduce stigma and other barriers to care for survivors when accessing health services, support the strengthening of needed specialty services, and build more resilient and self-sustaining health systems. The regional program sought to ensure the sharing of lessons learned and best practices across the three countries and the region through meetings, exchanges and conferences with partners such as NIH, WHO, and the West African Consortium. Funded by the Global Health Bureau through the Advancing Partners & Communities Project, John Snow Research & Training Institute implemented the program from July 2016 through July/August 2018.

1. Ebola Transmission Prevention & Survivor Services
Program, Guinea
June 2016-July 2018

2. Presentation Outline
• Background
• Program goal and expected results
• Transmission prevention:
monitoring survivor health status,
semen testing
• The challenges of rapid start up and a
limited program life
• Facility renovations to strengthen
WASH infrastructure
• The value of a strong national
survivor association
• Working with Key partners

3. Background
• 2014-15 Ebola outbreak in Guinea: 3,814 cases, 2,544
deaths, and 1,270 registered survivors with frequent
health complications.
• June 1, 2016—WHO declared the end of Ebola epidemic
in Guinea and recommended close monitoring.
• Research shows the persistence of the virus in survivors
but unknown for how long.
• Design and implementation of the active ring
surveillance program by the Ministry of Health (MOH)
National Agency for Health Security (NAHS) with
assistance from partners.

4. ETP&SS Goal and Expected Results
• Goal: To reduce or eliminate the risk of Ebola
transmission from survivors to others and to ensure
access to and effective delivery of health care services for
survivors.
• Expected Results
 Coordination with partners strengthened
 Surveillance system in place and operational
 Health care for survivors strengthened and survivors
receive treatment as needed
 Survivor Associations strengthened and stigma reduced.

5. Catchment Area of the Program
• 6 regions: Conakry, Kindia,
Nzerekore, Kakan, Boke and
Faranah
• Covers close to 100% of
Ebola survivors (1,270 total
in the country)

6. Transmission Prevention:
Monitoring survivor health status
• March 2017—Review of SA-Ceint
• Recommendations:
– Establish limited number of sentinel sites in all regions
where Ebola survivors live.
– Continue to monitor research results on bodily fluids
and continue semen test every 3 months.

7. Transmission Prevention:
Monitoring survivor health status
• Sentinel Site definition: geographic area in prefecture or
urban area where at least 5 survivors live.
• 60 sites in the 6 regions: Conakry, Kindia, Nzerekore,
Kakan, Faranah, Boke.
• Role: Collect information on the health status of
survivors and their immediate contacts and submit to
NAHS on a weekly basis.
• 98% of sentinel sites reported regularly.

8. Transmission Prevention:
Semen Testing
• APC planned and implemented three campaigns for
semen collection from male survivors aged 15 years and
older (n=440).
– 2nd and 3rd campaign in collaboration with the NIH
• APC assisted in providing a refresher training to 30
laboratory officers on how to collect and transport
semen to labs.
• APC procured lab products.
• On average, 86% of the target population provided
semen during the 3 campaigns.

9. The challenges of rapid start up and a limited
program life
• The limited program life could not allow some activities of
the program to be implemented and monitored for a
longer period of time to see the results and allow
sustainability. For example procuring medicines took a long
time and arrived a short time before he end of the
program.
• The program had to pay office rent for the survivor
network to cover 12 months after the end of the program.
• The MOH/NAHS requested to pursue the semen testing
well beyond the life of the program.

10. • 23 health facilities selected to be
strengthened in 6 regions with focus
on Conakry, Kindia, and Nzerekore.
• APC renovated 8 health facilities in
most affected zones with focus on
water and sanitation.
• Results: health personnel can wash
their hands to contribute to infection
prevention, bathrooms are clean, etc.
Facility renovations to strengthen WASH Infrastructure

11. The Value of a Strong National Survivor Association
• Guinea National Network of Ebola Survivors (RENASEG)
and 23 local associations.
• Support from program to implement action plan to
build RENASEG capacity:
– Result: election of new and strong leadership. RENASEG adopted
constitution and bylaws and is officially recognized by the government
,has office , receive funds from other agencies such as UNDP, Wakili
SA.
– Examples of important roles played by RENASEG include, reduction of
the stigma faced by its members by 77%, weekly collection of the
health status of its members and sensitization for semen collection.

12. • World Health Organization Guinea Office: Review of SA-
Ceint: cost sharing and participation in technical work. Participation in
several meetings to discuss issues . Participation in several activities
(program regional activities in Liberia and Guinea).
• NIH: Collaboration in the semen collection campaigns: second and third
rounds.
• Post- Ebogui: Information about survivors health status from Post -
Ebogui was the basis for the selection of medicines and quantification of
medicines to be procured by USAID for survivors in need. Development of
clinical care guideline and curriculum development based on Post -Ebogui’s
experience. Post- Ebogui gave presentations on their research results at
APC regional meetings.
Working with Key Partners

13. Conclusions
• Surveillance program implemented well to get weekly
information on health status of survivors available to the
NAHS/MOH. So far there has not been Ebola cases.
• Survivors Association Network strengthened and about
to become the National Go-To organization to assist all
vulnerable people in Guinea not just Ebola survivors.
Process of changing its name and scope is progressing
to be come (RENAPEVD-GUINEE ).