Ebola Outbreak In West Africa Research Articles

Operational Considerations in Global Health Modeling.

Epidemiological modeling and simulation can contribute cooperatively across multifaceted areas of biosurveillance systems. These efforts can be used to support real-time decision-making during public health emergencies and response operations. Robust epidemiological modeling and simulation tools are crucial to informing risk assessment, risk management, and other biosurveillance processes. The Defense Threat Reduction Agency (DTRA) has sponsored the development of numerous modeling and decision support tools to address questions of operational relevance in response to emerging epidemics and pandemics. These tools were used during the ongoing COVID-19 pandemic and the Ebola outbreaks in West Africa and the Democratic Republic of the Congo. This perspective discusses examples of the considerations DTRA has made when employing epidemiological modeling to inform on public health crises and highlights some of the key lessons learned. Future considerations for researchers developing epidemiological modeling tools to support biosurveillance and public health operations are recommended.

The nexus between post conflict societies and their capacity to respond to the ebola epidemic in Mano River Union

The Ebola crisis in the Mano River States and inadequate state responses to the outbreak heightened the challenges post conflict societies face during emergencies. There have been enough literature discussing the issues of Ebola especially in the Mano River Union; however, there is little discussion on the capacity of the Mano River Union to respond to the Ebola epidemic. Against this background, the study sought to investigate the nexus between post conflict societies and their capacity to respond to the Ebola epidemic in the Mano River Union. A non-empirical qualitative case study approach involving extensive review of secondary data in the form of books, journals, internet sites and conference papers was adopted. The results showed that all the countries in the sub-region were unprepared for the outbreak. Even though some countries had disaster management divisions, none had any disaster management plans in place hence the Ebola Virus Disease and its subsequent crisis could not have been anticipated. Following the findings, a strong case has been made for countries in the sub-region to have disaster management plans and other early warning and resilient systems in place in place to reduce the scale of the outbreak and the high number of deaths.

Health Management Workforce Capacity-Building in Liberia, Post-Ebola.

Following the Ebola crisis in Liberia in 2014–15, the Liberian Ministry of Health developed a strategy to build a fit-for-purpose health workforce, focusing on both health care providers and health managers. To help fulfill national capacity-building goals for health management, a team of faculty, staff, and practitioners from the Yale School of Medicine, the University of Liberia, the National Public Health Institute of Liberia, and the Ministry of Health collaboratively developed and launched the health management program in Liberia in July 2017. The team worked to build specific management and leadership competencies for healthcare workers serving in management and leadership roles in Liberia’s health sector using two concurrent strategies—1) implementation of a hospital-based partnership-mentorship model in the two largest hospitals in the capital city of Monrovia, and 2) establishment of an executive education-style advanced Certificate in Health Systems Leadership and Management at the University of Liberia. Here we describe the health management program in Liberia, its focus, and its evolution from program launch in 2017 to the present, as well as ongoing efforts to transition program activities to local partner ownership by the end of 2021.

Black Insecurity at the End of the World

“Black Insecurity at the End of the World” examines the sensibility I term black insecurity by reading Colson Whitehead’s 2010 novel Zone One against a backdrop of bioinsecurity and police murder of black people. The 2014 Ebola outbreak in West Africa and uprisings in Ferguson, Missouri, from the same year, when situated in dialogue with Whitehead’s text, show that black insecurity reframes the spatio-temporal notion of survival by unmasking security structures as dead and dying. Engaged from the standpoint of ongoing racial justice protests and stay-at-home conditions of the COVID-19 pandemic, “Black Insecurity at the End of the World” argues that black speculative fictions uniquely expose the false premises of securitization and show that black love is an essential process for unmaking the forces of anti-Blackness.

COVID-19, climate change, and communities

COVID-19, climate change, and communities

Heterologous prime-boost regimens with HAdV-5 and NDV vectors elicit stronger immune responses to Ebola virus than homologous regimens in mice.

The 2014 Ebola outbreak in West Africa resulted in more than 11,000 deaths, highlighting the need for a vaccine. A phase I clinical trial of a human adenovirus type 5 vector-based Ebola virus (EBOV) vaccine (HAdV-5-MakGP) showed that a homologous prime-boost regimen with HAdV-5 vaccine elicited a robust humoral response but a weak cellular immune response. Due to pre-existing anti-vector immunity, boosting with the same vaccine did not increase the magnitude of the cellular immune response, which contributes significantly to protection against EBOV infection. Here, we generated a recombinant Newcastle disease virus (NDV), based on the LaSota vaccine strain, expressing the GP protein of the EBOV variant Makona (rLS/EB-GP) using reverse genetics technology. The humoral and cellular immune responses to this vaccine candidate in mice immunized using a homologous prime-boost regimen or a heterologous prime-boost regimen with the HAdV-5-vectored Ebola vaccine were assessed using ELISA and ELISPOT assays. The ELISA and ELISPOT results showed that mice primed with rLS/EB-GP and boosted with HAdV-5-MakGP (NDV+HAdV-5) or, reversed, primed with HAdV-5-MakGP and boosted with rLS/EB-GP (HAdV-5+NDV) exhibited more-potent EBOV GP-specific antibody and cellular immune responses than those receiving the same vaccine twice. The most robust EBOV GP-specific antibody and T-cell responses were detected in the HAdV-5-MakGP-primed and rLS/EB-GP-boosted (HAdV-5+NDV) mice. These results suggest that the HAdV-5 prime-NDV boost regimen is more effective in stimulating EBOV-specific immunity than homologous regimens alone, indicating the potential boosting ability of the NDV vector in human vaccine use.

A linear noise approximation for stochastic epidemic models fit to partially observed incidence counts.

Stochastic epidemic models (SEMs) fit to incidence data are critical to elucidating outbreak dynamics, shaping response strategies, and preparing for future epidemics. SEMs typically represent counts of individuals in discrete infection states using Markov jump processes (MJPs), but are computationally challenging as imperfect surveillance, lack of subject-level information, and temporal coarseness of the data obscure the true epidemic. Analytic integration over the latent epidemic process is impossible, and integration via Markov chain Monte Carlo (MCMC) is cumbersome due to the dimensionality and discreteness of the latent state space. Simulation-based computational approaches can address the intractability of the MJP likelihood, but are numerically fragile and prohibitively expensive for complex models. A linear noise approximation (LNA) that approximates the MJP transition density with a Gaussian density has been explored for analyzing prevalence data in large-population settings, but requires modification for analyzing incidence counts without assuming that the data are normally distributed. We demonstrate how to reparameterize SEMs to appropriately analyze incidence data, and fold the LNA into a data augmentation MCMC framework that outperforms deterministic methods, statistically, and simulation-based methods, computationally. Our framework is computationally robust when the model dynamics are complex and applies to a broad class of SEMs. We evaluate our method in simulations that reflect Ebola, influenza, and SARS-CoV-2 dynamics, and apply our method to national surveillance counts from the 2013-2015 West Africa Ebolaoutbreak.

Imperfect diagnosis: The truncated legacies of Zika testing.

When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of ‘emergency R&D’ to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.

Review: Insights on Current FDA-Approved Monoclonal Antibodies Against Ebola Virus Infection.

The unprecedented 2013-2016 West Africa Ebola outbreak accelerated several medical countermeasures (MCMs) against Ebola virus disease (EVD). Several investigational products (IPs) were used throughout the outbreak but were not conclusive for efficacy results. Only the Randomized Controlled Trial (RCT) on ZMapp was promising but inconclusive. More recently, during the second-largest Ebola outbreak in North Kivu and Ituri provinces, Democratic Republic of the Congo (DRC), four IPs, including one small molecule (Remdesivir), two monoclonal antibody (mAb) cocktails (ZMapp and REGN-EB3) and a single mAb (mAb114), were evaluated in an RCT, the Pamoja Tulinde Maisha (PALM) study. Two products (REGN-EB3 and mAb114) demonstrated efficacy as compared to the control arm, ZMapp. There were remarkably few side effects recorded in the trial. The FDA approved both medications in this scientifically sound study, marking a watershed moment in the field of EVD therapy. These products can be produced relatively inexpensively and can be stockpiled. The administration of mAbs in EVD patients appears to be safe and effective, while several critical knowledge gaps remain; the impact of early administration of Ebola-specific mAbs on developing a robust immune response for future Ebola virus exposure is unknown. The viral mutation escape, leading to resistance, presents a potential limitation for single mAb therapy; further improvements need to be explored. Understanding the contribution of Fc-mediated antibody functions such as antibody-dependent cellular cytotoxicity (ADCC) of those approved mAbs is still critical. The potential merit of combination therapy and post-exposure prophylaxis (PEP) need to be demonstrated. Furthermore, the PALM trial has accounted for 30% of mortality despite the administration of specific treatments. The putative role of EBOV soluble Glycoprotein (sGP) as a decoy to the immune system, the virus persistence, and relapses might be investigated for treatment failure. The development of pan-filovirus or pan-species mAbs remains essential for protection. The interaction between FDA-approved mAbs and vaccines remains unclear and needs to be investigated. In this review, we summarize the efficacy and safety results of the PALM study and review current research questions for the further development of mAbs in pre-exposure or emergency post-exposure use.

Deployment of a Mobile Laboratory for the Control and Monitoring of High-Consequence Infectious Diseases: An Illustration With the Ebola Virus, the Biowarfare Agents, and the COVID-19

The novel coronavirus (COVID-19) pandemic has caused societal issues, economic and political tensions worldwide. This shows, once more, that dissemination of correct information based on scientific evidence together with a quick and concerted action is the key to build a sound capability for the management of biological emergencies. Here, we summarize the lessons learned from our preparedness and intervention during (i) our deployment during the 2014-2016 Ebola outbreak in West Africa; (ii) our large-scale exercises from Horizon 2020 Security program where the focus is on handling intentional dispersion of infectious agents; and (iii) our fight against COVID-19: by the deployment of Biological Light Fieldable Laboratory for Emergencies (B￾LiFE mobile laboratory) in Turin and Novara, Piedmont Region, Italy. At the latter deployment, the ultimate goal was a large screening for COVID-19 prevalence in primo intervention individuals. It cannot be ignored that the COVID-19 pandemic is an ideal situation to whet our preparedness, coordination of response and risks monitoring in case of future biological threats or attacks.

Implementing a Novel Nursing Site Manager Role in the Pediatric Emergency Department for Patient and Staff Safety During the COVID-19 Pandemic

Implementing a Novel Nursing Site Manager Role in the Pediatric Emergency Department for Patient and Staff Safety During the COVID-19 Pandemic

A perspective review of deadly viral diseases: An era of viruses

This review article overviewed briefly about the era of deadly viruses. Humans have been combating viruses since before our species had even evolved into its recent form. In some cases of viral infections, vaccines and antiviral drugs have allowed us to treat infections from spreading broadly, and have facilitated to patient recover. But it is far from over to fight the viruses. In recent decades, a number of viruses have sprung from animals to humans and have caused massive outbreaks, claiming thousands of lives such as the virus that led to the 2014-2016 Ebola outbreak in West Africa kills up to 90% of the population, making it the deadliest member of the Ebola family. But there are some viruses that are equally deadly, and some are even more deadly. Some viruses, including the novel coronavirus currently undergoing global outbreaks, have a low mortality rate but still pose a serious health risk as we have no means of access to the health facilities and scarcity of resources and infrastructure. Here we are reporting such type of ten deadly viruses. those have infected humans within last 50 years.

Public health emergencies and school attendance: What the Ebola crisis can teach us about the coming post-COVID education landscape

Using nine Demographic and Health Surveys for the three West African countries affected by the 2013−16 Ebola epidemic, this study applies a district-level interrupted time series (ITS) design to explore the longer-term impacts of the epidemic on school attendance. It shows that, about three to four years after the crisis, attendance has returned to the long-term trend regardless of the difference in Ebola virus disease prevalence among districts. The study also shows no discernable effect on the attendance trends for children from vulnerable backgrounds. However, it suggests further areas for examination and study. This includes migration patterns, the investment of emergency relief and overseas development aid between regions, the possible role of orphan status and early marriage (for girls) as vectors for the effect of the EVD crisis on educational outcomes and learnings losses for children who were out of school for up to an entire school year.

Factors associated with length of stay and treatment outcome of Ebola patients treated at an Ebola treatment center in Sierra Leone during the peak period of the West African Ebola outbreak 2013\u20132016

BackgroundThe World Health Organization (WHO) declared the West Africa Ebola epidemic as a Public Health Emergency of International Concern in August 2014. During the outbreak period, there were calls for the affected countries to construct Ebola treatment centres and reliable diagnostic laboratories closer to areas of transmission in order to improve the quality care of Ebola Virus Disease (EVD) patients. Delay in seeking treatment has been reported to have led to poor treatment outcome of EVD patients. Sierra Leone recorded more than 8000 probable and confirmed cases and more than 4000 EVD -related deaths nation-wide.MethodsIn this retrospective study, we investigated the effects of treatment delay, length of symptomatic period, EVD patients’ sex, age, occupation, region of residence, and clinical characteristics on the treatment outcome of 205 laboratory-confirmed EVD patients who were admitted at the Kenema Government Hospital Ebola Treatment Center (KGHETC) from 13/09/2014–26/11/2014; i.e. during the peak of 2013–2016 EVD outbreak in Sierra Leone. Specifically also, we determined the factors that were associated with the length of stay for EVD treatment for patients who were discharged alive.ResultsMajority (66.3%, n = 205/309) of the 309 suspected EVD patients with medical records at the KGHETC triage during the period under review were tested positive for EVD using reverse-transcriptase-polymerase chain reaction (RT-PCR) and had a definitive treatment outcome. Few (33.7%, n = 104/309) suspected EVD patients were not included in our analysis and were classified thus: 29.1% (n = 90/309) suspect EVD cases with negative RT-PCR results, 4.5% (n = 14/309) suspect cases with non-available RT-PCR result.Of the 205 patients, 99 (48.3%) had a fatal outcome. For EVD patients that survived, we recorded a significant association (− 0.06, 95% Confidence Interval (CI) = − 0.14 – - 0.02, p = 0.004) between the Length of Stay (LOS) and for each kilometer travelled to seek treatment at the KGHETC. However, the association between EVD patients that were low skilled workers (− 5.91, 95% CI = − 24.60 – 12.79, p = 0.73), EVD patients who were children and pupils in junior school (− 0.86, 95% CI = − 12.86 – 11.14, p = 0.73), health seeking delay for EVD patients who resided in Kenema District where the KGHETC was located (− 0.49, 95% CI = − 0.12 – 1.09, p = 0.24), sex (− 1.77, 95% CI = − 8.75 – 5.21, p = 0.50), age (0.21, 95% CI = − 0.36 – 0.77, p = 0.57), referral status (1.21, 95% CI = − 17.67 – 20.09, p = 0.89) and the LOS in surviving patients were not statistically significant.ConclusionThe high LOS for either treatment outcome for EVD patients that resided in the district in which the EVD treatment facility was located compared to those patients from other districts implies that health authorities should consider intensive health education with high priority given to seeking early EVD treatment, and the construction of strategic ETCs as important components in their response strategy.

Equitable and Feasible Distribution of SARS-CoV-2 Vaccines for All in Africa.

ABSTRACT.As the fight against the coronavirus disease 2019 (COVID-19) pandemic continues, the necessity for wide-scale, global vaccine rollout to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and slow its mutation rate remains unassailable. The COVID-19 Vaccines Global Access (COVAX) initiative’s campaign involves a proportional framework to finance and distribute SARS-CoV-2 vaccines in low- and middle-income countries. However, the COVAX framework has critical limitations, including limited funding and the failure to account for the special epidemic risks and needs of its participating nations, as recommended by the World Health Organization’s Strategic Advisory Group of Experts on Immunization framework. These drawbacks disproportionately impact Africa, where many nations rely on COVAX as their main source of vaccines. The current plan to vaccinate only up to 20% of participating nations’ populations is short-sighted from both epidemiologic and moral perspectives. COVAX must commit to vaccinating all of Africa and its initiative must be modified to account for the health and economic infrastructures in these countries. Lessons learned from successful vaccination campaigns, including the West African Ebola outbreak, have shown that vaccinating all of Africa is possible and feasible, and that infrastructure and human resources can support mass vaccination. To halt this global pandemic, global responsibility must be accepted to finance and equitably distribute SARS-CoV-2 vaccines to African nations. We urge COVAX to act swiftly to prevent Africa from becoming the new face of a persisting pandemic.

Developing a scalable framework for partnerships between health agencies and the Wikimedia ecosystem.

In this era of information overload and misinformation, it is a challenge to rapidly translate evidence-based health information to the public. Wikipedia is a prominent global source of health information with high traffic, multilingual coverage, and acceptable quality control practices. Viewership data following the Ebola crisis and during the COVID-19 pandemic reveals that a significant number of web users located health guidance through Wikipedia and related projects, including its media repository Wikimedia Commons and structured data complement, Wikidata. The basic idea discussed in this paper is to increase and expedite health institutions' global reach to the general public, by developing a specific strategy to maximize the availability of focused content into Wikimedia's public digital knowledge archives. It was conceptualized from the experiences of leading health organizations such as Cochrane, the World Health Organization (WHO) and other United Nations Organizations, Cancer Research UK, National Network of Libraries of Medicine, and Centers for Disease Control and Prevention (CDC)'s National Institute for Occupational Safety and Health (NIOSH). Each has customized strategies to integrate content in Wikipedia and evaluate responses. We propose the development of an interactive guide on the Wikipedia and Wikidata platforms to support health agencies, health professionals and communicators in quickly distributing key messages during crisis situations. The guide aims to cover basic features of Wikipedia, including adding key health messages to Wikipedia articles, citing expert sources to facilitate fact-checking, staging text for translation into multiple languages; automating metrics reporting; sharing non-text media; anticipating offline reuse of Wikipedia content in apps or virtual assistants; structuring data for querying and reuse through Wikidata, and profiling other flagship projects from major health organizations. In the first phase, we propose the development of a curriculum for the guide using information from prior case studies. In the second phase, the guide would be tested on select health-related topics as new case studies. In its third phase, the guide would be finalized and disseminated.

Building the Sierra Leone Ebola Database: organization and characteristics of data systematically collected during 2014–2015 Ebola epidemic

PurposeDuring the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS), the US Centers for Disease Control and Prevention, and responding partners under the coordination of the National Ebola Response Center (NERC) and the MoHS's Emergency Operation Center (EOC) systematically recorded information from the 117 Call Center system and district alert phone lines, case investigations, laboratory sample testing, clinical management, and safe and dignified burial records. Since 2017, CDC assisted MoHS in building and managing the Sierra Leone Ebola Database (SLED) to consolidate these major data sources. The primary objectives of the project were helping families to identify the location of graves of their loved ones who died at the time of the Ebola epidemic through the SLED Family Reunification Program and creating a data source for epidemiological research. The objective of this paper is to describe the process of consolidating epidemic records into a useful and accessible data collection and to summarize data characteristics, strength, and limitations of this unique information source for public health research. MethodsBecause of the unprecedented conditions during the epidemic, most of the records collected from responding organizations required extensive processing before they could be used as a data source for research or the humanitarian purpose of locating burial sites. This process required understanding how the data were collected and used during the outbreak. To manage the complexity of processing the data obtained from various sources, the Sierra Leone Ebola Database (SLED) Team used an organizational strategy that allowed tracking of the data provenance and lifecycle. ResultsThe SLED project brought raw data into one consolidated data collection. It provides researchers with secure and ethical access to the SLED data and serves as a basis for the research capacity building in Sierra Leone. The SLED Family Reunification Program allowed Sierra Leonean families to identify location of the graves of loved ones who died during the Ebola epidemic. ConclusionsThe SLED project consolidated and utilized epidemic data recorded during the Sierra Leone Ebola Virus Disease outbreak that were collected and contributed to SLED by national and international organizations. This project has provided a foundation for developing a method of ethical and secure SLED data access while preserving the host nation's data ownership. SLED serves as a data source for the SLED Family Reunification Program and for epidemiological research. It presents an opportunity for building research capacity in Sierra Leone and provides a foundation for developing a relational database. Large outbreak data systems such as SLED provide a unique opportunity for researchers to improve responses to epidemics and indicate the need to include data management preparedness in the plans for emergency response.

Development of a New Reverse Genetics System for Ebola Virus.

Ebola virus (EBOV) is a highly pathogenic negative-stranded RNA virus that has caused several deadly endemics in the past decades. EBOV reverse genetics systems are available for studying live viruses under biosafety level 4 (BSL-4) or subviral particles under BSL-2 conditions. However, these systems all require cotransfection of multiple plasmids expressing viral genome and viral proteins essential for EBOV replication, which is technically challenging and unable to naturally mimic virus propagation using the subviral particle. Here, we established a new EBOV reverse genetics system only requiring transfection of a single viral RNA genome into an engineered cell line that stably expresses viral nucleoprotein (NP), viral protein 35 (VP35), VP30, and large (L) proteins and has been fine-tuned for its superior permissiveness for EBOV replication. Using this system, subviral particles expressing viral VP40, glycoprotein (GP), and VP24 could be produced and continuously propagated and eventually infect the entire cell population. We demonstrated the authentic response of the subviral system to antivirals and uncovered that the VP35 amount is critical for optimal virus replication. Furthermore, we showed that fully infectious virions can be efficiently rescued by delivering the full-length EBOV genome into the same supporting cell, and the efficiency is not affected by genome polarity or virus variant specificity. In summary, our work provides a new tool for studying EBOV under different biosafety levels.IMPORTANCE Ebola virus is among the most dangerous viral pathogens, with a case fatality rate of up to 90%. Since 2013, the two largest and most complex Ebola outbreaks in Africa have revealed the lack of investigation on this notorious virus. A reverse genetics system is an important tool for studying viruses by producing mutant viruses or generating safer and convenient model systems. Here, we developed an EBOV life cycle modeling system in which subviral particles can spontaneously propagate in cell culture. In addition, this system can be employed to rescue infectious virions of homologous or heterologous EBOV isolates using either sense or antisense viral RNA genomes. In summary, we developed a new tool for EBOV research.

COVID-19 preparedness at health facilities and community service points serving people living with HIV in Sierra Leone.

After a decade of civil war and the 2014–2016 West African Ebola outbreak, Sierra Leone now faces the COVID-19 pandemic with a fragile health system. As was demonstrated during Ebola, preparedness is key to limiting a health crisis’ spread and impact on health systems and ensuring continued care for vulnerable populations including people living with HIV (PLHIV). To assess COVID-19 preparedness and inform interventions to ensure continuity of HIV services at health facilities (HFs) and community service points (CSPs), we conducted site readiness assessments in Freetown, the epicenter of COVID-19 in Sierra Leone. Data were collected at nine high-volume HIV HFs and seven CSPs in April 2020, a month after COVID-19 was declared a pandemic. CSPs comprised three community drop-in centers providing HIV counseling and testing services as well as HIV prevention services (e.g., condoms and lubricants) for key and priority populations and four community-based support groups serving PLHIV. At the time of assessment, CSPs did not provide antiretroviral therapy (ART) but were considered potential sites for expansion of differentiated service delivery (DSD)—a client-centered approach to HIV care—in the context of COVID-19. Overall, 5/9 HFs had trained staff on use of personal protective equipment (PPE) and prevention of COVID-19 transmission. Most had access to masks (5/9) and gloves (7/9) for management of suspected/confirmed COVID-19 cases, and 4/9 HFs had triage procedures for isolation of suspected cases. Conversely, few CSPs had access to masks (2/7) or gloves (2/7) and no staff were trained on PPE use or COVID-19 transmission. 7/9 HFs had adequate ART stock for multi-month dispensing though few had procedures for (3/9) or had trained staff in providing DSD (2/9). Among CSPs where measures were applicable, 2/4 had procedures for DSD, 1/3 had staff trained on DSD and none had adequate ART stock. Identification of gaps in COVID-19 preparedness is a critical step in providing support for infection control and modified service delivery. Findings from this assessment highlight gaps in COVID-19 preparedness measures at sites supporting PLHIV in Sierra Leone and indicate CSPs may require intensive supervision and training to ensure HIV services are uninterrupted while minimizing COVID-19 risk, especially if used as sites to scale up DSD.

Narrative in VR journalism: research into practice

ABSTRACT In 2015 The Tow Center for Journalism produced a live-motion virtual reality (VR) journalism story on the Ebola outbreak in West Africa, ‘Secret Location’. They stated that this new form appeared to change how journalists must construct their stories. They also challenged the industry to explore the journalistic application of VR beyond ‘highly produced documentaries’ (Owen et al. 2015. “Virtual Reality Journalism.” Tow Centre. CJR. https://www.cjr.org/tow_center_reports/virtual_reality_journalism.php). We decided to make a short news VR film that explored the construction of this form of media and asked which narrative characteristic engaged the viewer to continue watching in a medium where the viewer was already immersed in the storyworld. Our findings suggest that even when the VR technology immerses the viewer into an illusion of presence, the traditional characteristics of narrative, character, plot, and subject remain of fundamental importance in the construction of a news story, and, it was the tension of what happens next, that is the plot, that was the strongest narrative driver in this short journalistic VR film. We also reflect on some issues raised in the production of the piece, such as the time taken, the limitations of creative editing and whether the expectations that VR raises might impact on the experience of viewing a VR news items.