title: Impact of the Ebola epidemic on general and HIV care in Macenta, Forest Guinea, 2014.
abstract: OBJECTIVE
  The current Ebola epidemic massively affected the Macenta district in Forest Guinea. We aimed at investigating its impact on general and HIV care at the only HIV care facility in the district.
  
  
  METHODS
  Prospective observational single-facility study.
  
  
  METHODS
  Routinely collected data on use of general hospital services and HIV care were linked to Ebola surveillance data published by the Guinea Ministry of Health. In addition, we compared retention among HIV-infected patients enrolled into care in the first semesters of 2013 and 2014.
  
  
  RESULTS
  Throughout 2014, service offer was continuous and unaltered at the facility. During the main epidemic period (August-December 2014), compared with the same period of 2013, there were important reductions in attendance at the primary care outpatient clinic (-40%), in HIV tests done (-46%), in new diagnoses of tuberculosis (-53%) and in patients enrolled into HIV care (-47%). There was a smaller reduction in attendance at the HIV follow-up clinic (-11%). Kaplan-Meier estimates of retention were similar among the patients enrolled into care in 2014 and 2013. In a multivariable Cox regression analysis, the year of enrolment was not associated with attrition (hazard ratio 1.02; 95% confidence interval: 0.72-1.43).
  
  
  CONCLUSIONS
  The Ebola epidemic resulted in an important decrease in utilization of the facility despite unaltered service offer. Effects on care of HIV-positive patients enrolled prior to the epidemic were limited. HIV care in such circumstances is challenging, but not impossible.
authors.affiliation: aCentre Médical de Macenta, Mission Philafricaine, Conakry, Guinea bINSERM U897 - Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux cUniversité de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France dDepartment of Infectious Diseases, University Hospital Bern eInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland fDepartment of Infectious Diseases, University of Dakar, Senegal.
authors.forename: David
authors.initials: D
authors.lastname: Leuenberger
authors.forename: Jean
authors.initials: J
authors.lastname: Hebelamou
authors.forename: Stefan
authors.initials: S
authors.lastname: Strahm
authors.forename: Nathalie
authors.initials: N
authors.lastname: De Rekeneire
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D058872:Epidemics; D005260:Female; D016701:Guinea; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult