Time to care and factors influencing appropriate Sudan virus disease care among case patients in Uganda, September to November 2022

• DOI: 10.1016/j.ijid.2024.107073
• Publication Date: 2024-04-25T03:14:15Z
• Authors: Rebecca Akunzirwe; Simone Carter; Brenda N. Simbwa; Mercy W. Wanyana; Sherry R. Ahirirwe; Saudah K. Namubiru; Mackline Ninsiima; Allan Komakech; Alex R. Ario; Daniel Kadobera; Benon Kwesiga; Richard Migisha; Lilian Bulage; Helen N. Naiga; Jane F. Zalwango; Brian Agaba; Zainah Kabami; Marie G. Zalwango; Patrick King; Thomas Kiggundu; Peter C. Kawungezi; Doreen N. Gonahasa; Irene B. Kyamwine; Immaculate Atuhaire; Alice Asio; Sarah Elayeete; Edirisa J. Nsubuga; Veronica Masanja; Stella M. Migamba; Petranilla Nakamya; Rose Nampeera; Andrew Kwiringira; Mary Choi; Terrence Lo; Julie R. Harris
• Keywords: 03 medical and health sciences; 0302 clinical medicine; Healthcare seeking behavior; Ebola; Outbreak; Uganda; Infectious and parasitic diseases; RC109-216

Early isolation and care for Ebola Disease patients at Ebola Treatment Units (ETU) curb outbreak spread. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda.We included persons with RT-PCR-confirmed SVD with onset September 20-November 30, 2022. We categorized days from symptom onset to ETU entry ('delays') as short (≤2), moderate (3-5), and long (≥6); the latter two were 'delayed isolation'. We categorized symptom onset timing as 'earlier' or 'later,' using October 15 as a cut-off. We assessed demographics, symptom onset timing, and awareness of contact status as predictors for delayed isolation. We explored reasons for early vs late isolation using key informant interviews.Among 118 case-patients, 25 (21%) had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Earlier symptom onset increased risk of delayed isolation [cRR=1∙8, 95%CI (1∙2-2∙8)]. Awareness of contact status and SVD symptoms, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors.Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could expedite presentation to ETUs.