By Kemo Cham
Like many countries, Sierra Leone has long focused its response to the HIV/AIDS pandemic on the key populations – people who live a risky life style that exposes them to infection of the virus, like those who inject drugs, Men who have Sex with Men (MSM), sex workers and prisoners.
But a leading researcher in the country is calling for a rethink of this approach. Dr Suliaman Lakkoh says while it makes sense to target a group of people prone to the infectious disease to end its spread, it also makes sense to target the single largest point of convergence for these people – hospitals. He argues that prevalence is expected to be higher in the hospital, where people are sent to do test for all forms of diseases, than in any other risk group.
Dr Lakkoh tried to explain this in the form of a research he conducted towards the end of last year. The outcome of the study titled: ‘Low partner testing in high HIV prevalence setting in Freetown, Sierra Leone: A retrospective study,’ was published on Research Square in September 2019. Conducted at the Connaught Hospital in Freetown, the study looked at two key issues: Prevalence of HIV at a major referral hospital and Partner Testing.
Connaught is the largest referral hospital in Sierra Leone and it is home to the largest HIV clinic in the country.
Lakkoh and five co-researchers extracted data for 3, 808 adults clients who were tested at the clinic between January and December 2017. The findings revealed an HIV prevalence rate of about 25 percent of the study sample.
Dr Lakkoh, a physician working for the Ministry of Health and Sanitation and attached to Connaught, also lectures part-time at the country’s only medical school – the College of Medicine and Allied Health Sciences (COMAHS). Through his research expertise, he also provides technical support to various public health issues in the country, notably the National AIDS Control Programme.
The researcher told Politico that he believed understanding that facility based HIV prevalence was also high is very important and crucial in the fight against the virus.
“It will help planners and programmers to direct efforts in the hospital settings,” he said, noting that the hospital can also be a ground to encourage people who are tested to get treatment and in turn get their partners and the rest of their communities tested.
“That's the argument I made in the paper; that we should not just focus on people with high risk but also on places with high prevalence,” he stressed.
Sierra Leone’s focus on the key population was informed by a mode of transmission study by the National AIDS Control Programme in 2013 which identified about half a dozen most-at-risk population, including MSM, sex workers and transgender people. This group, according to that study, had the highest prevalence rate of HIV at 22 percent. Prevalence was also found to be high among uniformed personnel like the military, and prison inmates.
Latest Statistics from the National AIDS Secretariat (NAS) and UN agencies show that new infection rate of HIV continues to go down in Sierra Leone, albeit at a low pace.
As of 2018, 4, 100 new cases were recorded, down from 4, 700 new cases in 2015, according to the figures from NAS.
While this positions Sierra Leone as one of the countries with the lowest HIV prevalence rates in the world, there are concerns that out of the estimated 70, 000 people thought to be living with HIV, as of 2018, according to UNAIDS figures, only a minority really know their status.
Sierra Leone’s fight against HIV/AIDS has been impacted by lack of resources, particularly finance, as the country relies almost entirely on donor support to run its HIV programme.
The Network of HIV Positives (NETHIPS), an umbrella body of people living with HIV in the country, has repeatedly cited persistent drug stuck out as a serious concern.
There is also the issue of stigma and discrimination, which has forced many in Sierra Leone to refuse to disclose their identity.
Lakkoh said their findings on partner testing was also very important in that it informed on another crucial aspects of the response. According to the report, out of the sample studied, only 17 people had their partners tested. Out of this 56percent were HIV positive. Lakkoh interpreted this to mean that there was 56 percent chance of all those found to be positive for their partners to get infected.
He said the low rate of partner testing could be the result of the culture of stigma and discrimination HIV positive people face. He said people might not inform their partners about their status for fear of being abandoned.
The researcher said through targeting health facilities, approaches such as Assisted Partner Notification could be implemented effectively. This is an approach that aids people who are HIV positive to talk to their partners and get them to come for testing.
Lakko said the outcome of the study also argues in favour of self-testing, which could also solve the problem of couple testing.
And thanks partly to his work, the national HIV programme has started implementing the family testing programme. Through this approach, when someone from a particular community is tested and found to have HIV, the authorities go to this community and conduct random testing. So everyone that's there - it could be contacts or others - can be captured, instead of targeting the partners or family members, which could keep people away from testing.
The findings of this study were the subject of a huge debate sparked by what the researcher described as a misrepresentation of his work.
A report shared on social media in December claimed that the study exposed a higher prevalence of HIV in Sierra Leone than had been thought.
The subject of HIV prevalence has always proven to be a controversial one.
Sierra Leone has had a national prevalence rate of the infectious disease of 1.5 percent over the last 10 years. Some section of the largely suspicious public has constantly questioned the authenticity of this statistics which has been stagnant since 2008.
The social media report claimed that the study revealed that the country’s HIV had jumped from 1.5 percent to 25 percent.
Lakkoh denied that this was what the study concluded. He said it was very clear that this was not a national study and that it was a hospital based study where a high prevalence was expected among people who were tested.
“We did not actually have any statement quoting an increase in prevalence from 1.5 to 25 percent,” he said.
“You would expect that in a referral hospitals like this prevalence is higher because you have a lot of people coming with a lot of diseases. But also there are more likely to be cases of HIV in hospitals than in the communities.
“For every study, there are limitations, and there is a clearly stated limitation in this study,” he said.
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