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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 4 - EBODAC (Communication strategy and tools for optimizing the impact of Ebola vaccination deployment â€“ Sofia ref.: 115847)

Teaser

Summary

The Ebola virus disease (EVD) epidemic infected more than 28.000 people and killed more than 11.000 from March 2014 to December 2015, the vast majority of them in Guinea, Liberia and Sierra Leone (WHO Ebola Situation Report June 10, 2016). No therapy or vaccine has been globally licensed yet for the treatment or prevention of EVD, but research led by a number of industrial, academic and non-profit stakeholders is relentlessly pursued.

The overall objective of EBODAC is to develop a communication and community engagement strategy, including the development and deployment of appropriate technologies and tools, to maximize the impact of Ebola vaccination. Complex social and cultural hurdles may impact vaccine acceptance by local populations. In the likely scenario of an Ebola vaccine deployment, ensuring adequate population coverage will be essential. Vaccination acceptance and compliance with the 2 dose vaccination regimen will be critical to high vaccination coverage. This includes the development of solutions for correctly identifying individuals returning for their second vaccination and reminding them of clinic visits. EBODAC deliverables include the development and implementation of:

1 A communication and community engagement strategy and tools to increase acceptance of and compliance with Ebola vaccination and build trust in vaccination with the broader population,
2 A mobile technology platform to allow effective recall of vaccine recipients to receive the second vaccination in the context of a heterologous prime-boost vaccine regimen,
3 An identification tool that ensures that the right person will receive the second vaccination in the context of a prime-boost vaccine regimen.

Work performed

The EBODAC project continues support to the EBOVAC-Salone vaccine study and in 2018 started support to the PREVAC study. Both studies are taking place in Kambia, Sierra Leone. All 3 components of the EBODAC project have been developed and adapted to the different age cohorts being recruited in the studies.

Key stakeholders, community leaders, community members & study participants have joined efforts with EBODAC and EBOVAC-Salone/PREVAC teams to make the trials happen. Potential barriers & opportunities for the clinical trials have been identified and communication has been adapted accordingly. Messages, communication materials & strategies have also been updated in line with the evolution of the trial designs.

As a result of the community engagement activities and efforts since the beginning of the project, enrolment into the EBOVAC-Salone and PREVAC trials is now complete. 3,798 people have expressed their interest in volunteering for the EBOVAC-Salone clinical trial; 1,630 individuals have attended the initial screening visit. 1,020 participants have received the 1st vaccination of the regimen and 946 of them have returned to the trial clinic to receive the boost. In addition, 1,327 people have expressed their interest in volunteering for the PREVAC clinical trial; 708 participants have received the 1st vaccination and 634 of them have returned to the trial clinic to receive the boost.

The mobile technology platform supports the clinical team to effectively recall participants to receive the second vaccine or attend clinic visits and has been successfully deployed and adapted to the needs of a multilingual population with a high rate of illiteracy and a lack of familiarity with clinical trials. To date, 96.6% of participants consented to be contacted through their mobile phone and 56.7% of calls were picked up. The ability of the mobile platform to generate daily clinic reports for the clinical trial staff has also been of added value to the clinical team.

A biometric identification tool combining finger-print and iris scan has been chosen, accepted by study participants and successfully used to register and recognize EBOVAC-Salone clinical trial participants. A mobile version of the biometric identification tool using iris scan on a portable tablet is currently in use in PREVAC.

A Mobile Training and Support (MOTS) service aims to strengthen the training Ministry of Health and Sanitation (MoHS) provides to Community Health Workers (CHWs). Trainings, initially focusing on the importance of immunization and outbreak response, are given through mobile phones without the need of a Smartphone. A pilot of MOTS has been executed with 125 CHWs in Bo, Sierra Leone. The goal is to make MOTS a mobile phone flexible training tool that can be expanded in terms of content, geography and transferred to Sierra Leone MoHS and other countries as a legacy of EBODAC.

Following extensive stakeholder engagement and dialogue, official MoHS permission to implement EBODACâ€™s Gap Analysis Project has been granted in Sierra Leone, Senegal and Uganda and Project Steering Committees have been established and convened in each country. A rapid literature review and expert consultation activities (including co-production â€˜jamsâ€™ and 1:1 consultations) have been conducted across the three project countries, engaging more than 220 individuals. The results from both processed have been synthesised and triangulated in order to build a sound evidence-base for the 2019 development of a Gap Analysis Tool for Ebola Vaccine Deployment. The tool will be able to be used by ministries of health across sub-Saharan Africa to help them assess their own readiness to reactively deploy an Ebola vaccine, from a demand-side perspective (considering communications, community engagement and compliance tracking).

Final results

Communication and engagement strategies are often developed along with vaccination programs, but the specific context of a clinical trial in an outbreak setting was a unique situation with major challenges that have been successfully overcome. Lessons learnt from this experience, together with lessons learnt on the use of enabling technologies, have been shared during the EBODAC symposium on communication, community engagement and enabling technology in Ebola clinical trials. An online training tool and guidebook have been developed to further share these learnings.

The external impacts of EBODAC & EBOVAC1 encompass capacity building for Sierra Leonean staff in Kambia through employment, experience and training on clinical trials, community engagement, use of mobile, biometric identification, development of Mobile Training and Support Service (MOTS) for Community Health Workers (CHWs) and other technological tools.
Locally, EBODAC has employed 15 mobile technology workers (10 MOTS & 5 MOTECH) and 12 identification tool operators ( 7 EBOVAC & 5 PREVAC). With regard to the community engagement, a joint EBODAC/ EBOVAC1 community liaison team has hired 5 staff employed by the Sierra Leone COMAHS and 6 staff employed by World Vision to work on EBOVAC-Salone; and 6 staff employed by the Sierra Leone COMAHS and 6 staff employed by World Vision to work on PREVAC. These staff are co-managed by supervisors from EBODAC and EBOVAC1.

Local capacity building efforts to prepare for trials in Sierra Leone and to train local Kambian staff will contribute to building research capacity in the country, including capacity to conduct research in epidemic/outbreak conditions. The successful implementation of educational measures, communication strategies and mechanisms to ensure proper handling of clinical data will contribute to the optimal performance of clinical trials in Sierra Leone in future.