title: Ebola outbreak response; experience and development of screening tools for viral haemorrhagic fever (VHF) in a HIV center of excellence near to VHF epicentres.
abstract: BACKGROUND
  There have been 3 outbreaks of viral hemorrhagic fever (VHF) in Uganda in the last 2 years. VHF often starts with non-specific symptoms prior to the onset of haemorrhagic signs. HIV clinics in VHF outbreak countries such as Uganda see large numbers of patients with HIV 1/2 infection presenting with non-specific symptoms every day. Whilst there are good screening tools for general health care facilities expecting VHF suspects, we were unable to find tools for use in HIV or other non-acute clinics.
  
  
  METHODS
  We designed tools to help with communication to staff, infection control and screening of HIV patients with non-specific symptoms in a large HIV clinic during the outbreaks in Uganda. We describe our experiences in using these tools in 2 Ebola Virus Disease outbreaks in Uganda.
  
  
  RESULTS
  During the Ebola Virus Disease (EVD) outbreaks, enhanced infection control and communication procedures were implemented within 24 hours of the WHO/Ministry of Health announcement of the outbreaks. During course of these outbreaks the clinic saw 12,544 patients with HIV 1/2 infection, of whom 3,713 attended without an appointment, suggesting new symptoms. Of these 4 were considered at risk of EVD and seen with full infection procedures; 3 were sent home after further investigation. One patient was referred to the National Referral Hospital VHF unit, but discharged on the same day. One additional VHF suspect was identified outside of a VHF outbreak; he was transferred to the National Referral Hospital and placed in isolation within 2 hours of arriving at the HIV clinic.
  
  
  CONCLUSIONS
  Use of simple screening tools can be helpful in managing large numbers of symptomatic patients attending for routine and non-routine medical care (including HIV care) within a country experiencing a VHF outbreak, and can raise medical staff awareness of VHF outside of the epidemics.
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Parkes-Ratanshi
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda; Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Ali
authors.initials: A
authors.lastname: Elbireer
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda.
authors.forename: Betty
authors.initials: B
authors.lastname: Mbambu
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda.
authors.forename: Faridah
authors.initials: F
authors.lastname: Mayanja
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda.
authors.forename: Alex
authors.initials: A
authors.lastname: Coutinho
authors.affiliation: Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda; Trinity College Dublin, Dublin, Ireland; Northwestern University, Chicago, Illinois, United States of America.
authors.forename: Concepta
authors.initials: C
authors.lastname: Merry
mesh_terms: D000328:Adult; D060085:Coinfection / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006284:Health Plan Implementation; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D014454:Uganda / Q000453:epidemiology