Why are we here?
After two years of heavy involvement tackling the deadly Ebola epidemic in Guinea, Doctors Without Borders (MSF) closed its last Ebola-related project in 2016.
From January to September, MSF worked in Conakry, Coyah, Dubreka and Forécariah, treating 359 survivors and 282 health professionals for medical complications (primarily eye and neurological problems).
These health professionals had been involved in the fight against Ebola but no specialist support was available for them.
MSF also treated 354 people indirectly affected by the epidemic such as family members of victims.
These activities were both medical and psychological, as many people were suffering from mental health problems such as depression and post-traumatic stress disorder.
In addition, over 18,000 people benefited from information sessions designed to reduce the stigma still affecting Ebola survivors.
By September, as survivors were no longer experiencing medical complications, there was no further need for specialised treatment.
Meanwhile, the care of patients in need of psychological support was handed over to the Ministry of Health and other organisations such as Postebogui.
The closure of the survivor project marks the end of MSF’s direct involvement in medical activities related to Ebola, although it is constructing a treatment centre for infectious diseases with outbreak risks (including Ebola) in Guéckédou as part of E-prep.
Caring for people with advanced HIV
People living with HIV in Guinea have difficulty accessing antiretrovirals (ARVs), as supplies are frequently disrupted.
While Guinea has a relatively low prevalence of HIV, at around 1.7 per cent, the country has one of the worst treatment coverage rates in the world, with only one in four people living with HIV receiving ARVs.
In November, in collaboration with the Ministry of Health, MSF opened a 31-bed centre in Donka hospital to treat people suffering from advanced HIV.
Staff had seen the high numbers of people with late-stage HIV at the Matam outpatient centre in Conakry and wanted to address the lack of specialised inpatient care in Guinea.
The Donka centre offers free, high-quality care to HIV patients with diseases such as Kaposi’s sarcoma and cryptococcal meningitis that result from low immunity.
It also conducts operational research and provides hands-on medical training to improve the overall quality of care. By the end of December, the centre had treated 49 people with advanced HIV, of whom 44 per cent had a CD4 count below 100, an indication that the immune system is severely compromised and vulnerable to deadly opportunistic infections.
Regular HIV activities
At the end of 2016, MSF was providing medical care for 9,856 people living with HIV, including drugs for opportunistic infections, laboratory tests, and psychosocial support.
Of these, 4,968 people receive six-month supplies of ARVs through a refill strategy called R6M, which was first piloted during the Ebola outbreak to ensure that stable patients remained on treatment.
MSF has gradually handed over the provision of ARVs to a large patient cohort to the national health ministry, and by the end of 2016, was providing first-line ARVs to 2,573 patients on Conakry.
Over 94 per cent of the HIV patients on R6M were still under treatment after 24 months, compared to only 61 per cent of those receiving monthly supplies.
The national HIV programme has shown interest in a wider roll-out of this model of care.
MSF also provides hands-on training and mentoring for health staff, as well as drugs for opportunistic infections and socioeconomic support for 9,856 HIV patients in six Ministry of Health centres across Conakry.
No. staff in 2016: 214 | Expenditure: €5.9 million | Year MSF first worked in the country: 1984 | msf.org/guinea