UCL GRAND CHALLENGE OF
GLOBAL HEALTH
HIV in Post-Conflict Sierra Leone
Dr Andrew Copas
Dr Maria Kett
Ms Nataliya Brima, Ms Ibidun Fakoya, Dr Fiona Burns,
Dr Pam Sonnenberg, Dr Audrey Prost (UCL)
Infection and Population Health
Epidemiology and Public Health
Dr Brima Kargbo, National Aids Secretariat (NAS),
Sierra Leone
Background
Outputs and Impacts
Population surveys show that HIV prevalence in Sierra Leone rose
from 0.9% in 2002 to 1.5% in 2005, before stabilising at 1.5% in 2008.
HIV is one of a number of public health challenges in Sierra Leone
and is a major concern to national and international health agencies
keen to prevent an epidemic similar to those seen in Eastern and
Southern Africa
• First paper based on secondary analysis to be submitted in 2013
• Expected improvement in quality of HIV surveillance activity in Sierra
Leone, and research opportunities
Example: HIV Testing In 2008 only around 10% of the population
had been tested for HIV. Excluding HIV positive individuals who are
aware of their status we see individuals are more likely to have been
tested if they live in cities, are married, female, have completed higher
education, use condoms, or have knowledge of HIV
Aims and objectives
The project aims to conduct secondary data analysis to assess the
population HIV risk and HIV knowledge, and associations with HIV
infection, and access to HIV testing, post-diagnosis care and
antiretroviral therapy
The project also aims to establish a research collaboration between
NAS and UCL and provide technical and strategic support to NAS to
facilitate research projects and improve surveillance activities
Cross disciplinary
This project represents a collaboration between clinicians, social
scientists, epidemiologists and statisticians at UCL and clinicians and
epidemiologists at NAS
Completed activities
• Initial meeting in London and a series of meetings at NAS in
February 2011
• Discussions and visits to advise on electronic data capture of
clinical records and HIV testing forms
• Ethical approval for secondary data analyses from the Ethics
Committee of the Ministry of Health and Sanitation, Sierra Leone
• Initial data analysis to address our shorter term objectives
Planned activities
• Completion of secondary data analysis by end 2012
• Further technical advice on data capture
• Collaboration on new research and surveillance projects
Challenges
• Difficulties securing sufficiently detailed information from past
surveys has prevented an analysis of change over time
• Hence we have focussed initially on analysis of the 2008
Demographic and Health Survey (ref)
• Existing clinical data systems present some problems
% HIV tested
(n)
Variable
Total
Socio-demographic factors
Age
15-24
25-34
35-44
45-59
Residence
Urban
Rural
Marital Status
Married
Unmarried
Sep/div/wid
Adjusted OR
(95% CI)
10 (673)
9.9 (182)
13.3 (253)
11.5 (180)
6.7 (58)
18.3 (442)
6.5 (231)
11.1 (417)
10.7 (218)
11.5 (38)
Gender
Male
Female
8.9 (233)
12.6 (440)
No education
Primary
Secondary+
6.6 (221)
10.7 (85)
20.0 (359)
Educational level
Age at first sex
14&under
15-16
17-18
19&older
Behaviour, HIV knowledge
Used condom at last
sex
No
Yes
Reduce HIV through
condom use
No
Yes
Don’t know
Healthy looking
person can have HIV No
Yes
Don’t know
Reduce HIV by not
having sex at all
Yes
No
Don’t know
Odds ratio
(95% CI)
8.7 (97)
10.6 (201)
15.5 (198)
11.7 (164)
11.3 (476)
23.0 (57)
11.4 (73)
15.5 (532)
7.4 (65)
11.1 (93)
16.1 (493)
7.7 (76)
16.1 (152)
14.4 (466)
7.1 (54)
P=0.0001
1
1.40 (1.09-1.79)
1.19 (0.92-1.53)
0.66 (0.47-0.93)
P<0.0001
P=0.015
1
1
0.31 (0.23-0.41) 0.67 (0.48-0.93)
P=0.928
P=0.0001
1
1
0.97 (0.77-1.21) 0.56 (0.42-0.73)
1.04 (0.69-1.58) 0.55 (0.28-1.06)
P=0.0007
1
1.48 (1.18-1.86)
P<0.0001
1
1.70 (1.29-2.24)
3.56 (2.79-4.60)
P=0.0001
1
1.25 (0.94-1.67)
1.94 (1.44-2.60)
1.40 (1.05-1.86)
P<0.0001
1
3.63 (2.82-4.66)
P<0.0001
1
1.61 (1.10-2.37)
2.60 (1.90-3.57)
P=0.036
1
1.36 (0.93-1.95)
1.67 (1.17-2.51)
1.66 (1.07-2.40)
P<0.0001
1
2.36 (1.62-3.42)
P<0.0001
1
1.43 (1.06-1.93)
0.62 (0.40-0.97)
P<0.0001
1
1.55 (1.15-2.08)
0.67 (0.43-1.04)
P=0.0004
1
0.88 (0.69-1.12)
0.40 (0.25-0.63)
P=0.005
1
1.81 (1.20-2.74)
P=0.0015
1
1.46 (1.00-2.12)
0.78 (0.47-1.28)
p<0.0001
1
1.42 (1.02-1.98)
0.99 (0.63-1.54)
P=0.029
1
0.46 (0.22-0.96)
1.08 (0.45-2.62)
Table: Associations with HIV testing, 2008
Conclusions
• A research collaboration has been established with NAS
• Analysis of existing data can be challenging, collaboration from
inception in future HIV projects will have greater impact
Photo: Dr Andrew Copas and Ms Nataliya Brima with Dr Brima
Kargbo at NAS
Reference: Statistics Sierra Leone (SSL) and ICF Macro. 2009. Sierra Leone Demographic and Health Survey
2008.Calverton, Maryland, USA: Statistics Sierra Leone (SSL) and ICF
Contact: Dr Andrew Copas, a.copas@ucl.ac.uk