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According to World Health Organization (WHO) data, the Ebola virus disease (Ebola) outbreak that began in West Africa in 2014 has resulted in 28,603 cases and 11,301 deaths (1). In March 2015, epidemiologic investigation and genetic sequencing in Liberia implicated sexual transmission from a male Ebola survivor, with Ebola virus detected by reverse transcription-polymerase chain reaction (RT-PCR) 199 days after symptom onset (2,3), far exceeding the 101 days reported from an earlier Ebola outbreak (4). In response, WHO released interim guidelines recommending that all male survivors, in addition to receiving condoms and sexual risk reduction counseling at discharge from an Ebola treatment unit (ETU), be offered semen testing for Ebola virus RNA by RT-PCR 3 months after disease onset, and every month thereafter until two consecutive semen specimens collected at least 1 week apart test negative for Ebola virus RNA (5). Male Ebola survivors should also receive counseling to promote safe sexual practices until their semen twice tests negative. When these recommendations were released, testing of semen was not widely available in Liberia. Challenges in establishing and operating the first nationwide semen testing and counseling program for male Ebola survivors included securing sufficient resources for the program, managing a public health semen testing program in the context of ongoing research studies that were also collecting and screening semen, identification of adequate numbers of trained counselors and appropriate health communication messages for the program, overcoming Ebola survivor-associated stigma, identification and recruitment of male Ebola survivors, and operation of mobile teams.

The 2014–16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64–100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region., Author summary We describe a model of a mobile laboratory co-located at an Ebola treatment unit (ETU) equipped with GeneXpert molecular diagnostic platform and automated qRT-PCR test for Ebola virus disease (EVD). The laboratory contributed significantly to the EVD response in Liberia, including supporting surveillance, outbreak detection, contact tracing and management of confirmed cases. The laboratory was run by local laboratory technicians as opposed to international experts on short missions, making it a more sustainable option in prolonged outbreaks and early recovery phases. The redeployment and strategic placement of these GeneXpert instruments to complement EVD isolation facilities throughout the country has strengthened preparedness and response capabilities for future EVD outbreaks in Liberia.

The International Bioethics Committee (IBC) of UNESCO was created in 1993 to provide leadership and influence the culture of bioethics in science and medicine and to ensure that human dignity, human rights and fundamental freedoms are respected. In the last two decades, the IBC has contributed immensely to the development of Bioethics in Africa by supporting the establishment of National Bioethics Committees, strengthening the capacity of these committees, training teachers in bioethics and providing ongoing direction in addressing bioethical issues in the life sciences. Africa is also represented on the membership of UNESCO-IBC and contributes to the global IBC agenda. Africa has a rich diversity of cultures and the growth of bioethics in Africa is varied as there are few trained bioethicists and few institutions of higher learning that teach bioethics. Inadequate resource mobilization to fulfill the bioethical agenda, slow progress in terms of bioethics education in Africa and the lack of a vibrant culture of bioethical discourse are among the challenges. In Africa, it is important to also engage the public in bioethical debates.

Ebola virus is known to persist in semen of male survivors of Ebola virus disease (EVD). However, maximum duration of, or risk factors for, virus persistence are unknown. We report an EVD survivor with preexisting HIV infection, whose semen was positive for Ebola virus RNA 565 days after recovery from EVD.