HIV care

Human immunodeficiency virus (HIV) is an infection that attacks the body's immune system, making it difficult to fight off infections. However, HIV is easily treatable: consistent treatment with HIV medications (known as antiretrovirals or ‘ART’), can suppress the virus to level that is undetectable - preserving the immune system and preventing transmission of the virus. Despite ART being available for many years now, HIV remains a common diagnosis in Sierra Leone. Unfortunately, in Masanga hospital we still see many presentations of advanced HIV – commonly known as ‘AIDS’. Although it is still possible to treat advanced HIV, patients may be severely unwell with many co-existent infections, and mortality is sadly much higher. 

Since 2021, we have been working to improve the HIV services in Masanga hospital. Initially, Masanga had no dedicated staff members specialising in HIV. We have trained a Community Health Officer (CHO) and two specialist HIV nurses. Patient counselling is provided in a newly created dedicated clinic room in a sensitive manner by our specialist nurses, who also provide ART and medication to prevent co-infections. Our specialist CHO provides support to complex and unwell patients. This specialist team undertake a dedicated weekly review of all hospital inpatients who are living with HIV, and monitor and follow up all outpatients on treatment.

We have ongoing work in strengthening access to medication and diagnostic tests. Through collaboration with other organisations in the country, we have improved our access to first-line ART, and have new tests available that help us diagnose common co-infections such as Tuberculosis. Alongside this, we have developed hospital specific guidelines for management of HIV and TB to support hospital clinicians in providing care for patients with HIV. For complex cases requiring alternative ART due to issues such as drug resistance, we have established referral pathways with other hospitals throughout Sierra Leone.

Daniel - one of our newly trained HIV staff

Although we have taken initial steps, there is still much more we can do to improve the care that patients attending Masanga hospital receive!

Although supplies of first-line ART have improved, we hope to provide more individually tailored treatment – such as kidney-friendly regimes for patients with kidney disease. We have supported our HIV team with training regarding new medication regimes, and now plan to routinely provide these to patients. We also aim to strengthen our supply of medications for prevention or treatment of co-existent infections, which should be provided free of charge.

Ongoing training and support of specialist staff members remains key. As well as ongoing nurse training, our CHO will attend an online course facilitated by the University of Washington regarding clinical management of HIV. We are in the process of establishing monthly multi-disciplinary meetings for the most unwell and complex patients, to ensure they are receiving the best possible care.