abstract: 'Background

  During the 2013-2016 West Africa Ebola outbreak, supportive care was the

  only non-experimental treatment option for patients with Ebola virus

  disease (EVD). However, providing care that would otherwise be routine

  for most clinical settings in the context of a highly contagious and

  lethal pathogen is much more challenging. The objective of this study

  was to document and deepen understanding of barriers to provision of

  supportive care in Ebola treatment units (ETUs) as perceived by those

  involved in care delivery during the outbreak.

  Methods

  This qualitative study consisted of 29 in-depth semi-structured

  interviews with stakeholders (decision-makers, physicians, nurses)

  involved in patient care delivery during the outbreak. Analysis

  consisted of interview debriefing and team-based transcript coding in

  NVivo10 software using thematic analysis.

  Findings

  Participants emphasized three interconnected barriers to providing

  high-quality supportive care during the outbreak: 1) lack of material

  and human resources in ETUs; 2) ETU organizational structure limiting

  the provision of supportive clinical care; and 3) delayed and poorly

  coordinated policies limiting the effectiveness of global and national

  responses. Participants also noted the ethical complexities of defining

  and enacting best clinical practices in low-income countries. They noted

  tension between, on one hand, scaling up minimal care and investing in

  clinical care preparedness to a level sustainable in West Africa and, on

  the other, providing a higher level of supportive care, which in

  low-resource health systems would require important investments.

  Conclusion

  Our findings identified potentially modifiable barriers to the delivery

  of supportive care to patients with EVD in West Africa. Addressing these

  in the inter-outbreak period will be useful to improve patient care and

  outcomes during inevitable future outbreaks. Promoting community trust

  and engagement through long-term capacity building of the healthcare

  work-force and infrastructure would increase both health system

  resilience and ability to handle other outbreaks of emerging diseases.'
affiliation: 'Loignon, C (Corresponding Author), Univ Sherbrooke, Fac Med \& Hlth
  Sci, Sherbrooke, PQ, Canada.

  Loignon, Christine; Couturier, Francois; Benhadj, Lynda; Lamontagne, Francois, Univ
  Sherbrooke, Fac Med \& Hlth Sci, Sherbrooke, PQ, Canada.

  Nouvet, Elysee, Univ Western Ontario, Sch Hlth Studies, London, ON, Canada.

  Adhikari, Neill K. J.; Fowler, Rob A., Univ Toronto, Interdept Div Crit Care, Dept
  Crit Care Med, Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada.

  Murthy, Srinivas, Univ British Columbia, Fac Med, Vancouver, BC, Canada.'
article-number: e0201091
author: Loignon, Christine and Nouvet, Elysee and Couturier, Francois and Benhadj,
  Lynda and Adhikari, Neill K. J. and Murthy, Srinivas and Fowler, Rob A. and Lamontagne,
  Francois
author-email: Christine.Loignon@Usherbrooke.ca
author_list:
- family: Loignon
  given: Christine
- family: Nouvet
  given: Elysee
- family: Couturier
  given: Francois
- family: Benhadj
  given: Lynda
- family: Adhikari
  given: Neill K. J.
- family: Murthy
  given: Srinivas
- family: Fowler
  given: Rob A.
- family: Lamontagne
  given: Francois
da: '2023-09-28'
doi: 10.1371/journal.pone.0201091
files: []
issn: 1932-6203
journal: PLOS ONE
keywords-plus: EPIDEMIC
language: English
month: SEP 5
number: '9'
number-of-cited-references: '32'
orcid-numbers: 'Murthy, Srinivas/0000-0002-9476-839X

  Nouvet, Elysee/0000-0002-1607-3453

  Ansumana, Rashid/0000-0002-1973-7200

  Lamontagne, Francois/0000-0002-0360-3427'
papis_id: 51a173f357f75adc2fcca1d5ad1b945d
ref: Loignon2018barrierssupportive
researcherid-numbers: 'Murthy, Srinivas/AAS-7243-2020

  '
times-cited: '14'
title: 'Barriers to supportive care during the Ebola virus disease outbreak in West
  Africa: Results of a qualitative study'
type: Article
unique-id: WOS:000443789900003
usage-count-last-180-days: '0'
usage-count-since-2013: '12'
volume: '13'
web-of-science-categories: Multidisciplinary Sciences
year: '2018'