Development of risk reduction behavioral counseling for Ebola virus disease survivors enrolled in the Sierra Leone Ebola Virus Persistence Study, 2015-2016

Abstract

Background: During the 2014-2016 West Africa Ebola Virus Disease (EVD) epidemic, the public health community had concerns that sexual transmission of the Ebola virus (EBOV) from EVD survivors was a risk, due to EBOV persistence in body fluids of EVD survivors, particularly semen. The Sierra Leone Ebola Virus Persistence Study was initiated to investigate this risk by assessing EBOV persistence in numerous body fluids of EVD survivors and providing risk reduction counseling based on test results for semen, vaginal fluid, menstrual blood, urine, rectal fluid, sweat, tears, saliva, and breast milk. This publication describes implementation of the counseling protocol and the key lessons learned.

Methodology/principal findings: The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol was developed from a framework used to prevent transmission of HIV and other sexually transmitted infections. The framework helped to identify barriers to risk reduction and facilitated the development of a personalized risk-reduction plan, particularly around condom use and abstinence. Pre-test and post-test counseling sessions included risk reduction guidance, and post-test counseling was based on the participants' individual test results. The behavioral counseling protocol enabled study staff to translate the study's body fluid test results into individualized information for study participants.

Conclusions/significance: The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol provided guidance to mitigate the risk of EBOV transmission from EVD survivors. It has since been shared with and adapted by other EVD survivor body fluid testing programs and studies in Ebola-affected countries.

Fig 1. Visit flow chart. The Ebola Virus Persistence Risk Reduction Behavioral Counseling Protocol visit flow chart.

(A) Visit 1 Description of EBOV pre-test counseling, and HIV pre and post-test counseling procedures. (B)Visit 2 Description of EBOV post-test counseling part 1 and 2 procedures. (C) Visit 3 Description of procedures if at least one positive, indeterminate, or no interpretation qRT-PCR test results was found, or if all body fluid specimens were found qRT-PCR negative. (D) Visit 4 and Beyond: Description of repeat visits until two consecutive negative qRT-PCR test results for all body fluid specimens.