{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:22:09Z","timestamp":1790421729378,"version":"4.1.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Sitaraman Family Foundation"},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["R01 EY029594"],"award-info":[{"award-number":["R01 EY029594"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["K23 EY030158"],"award-info":[{"award-number":["K23 EY030158"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["P30 EY06360"],"award-info":[{"award-number":["P30 EY06360"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013884","name":"Macula Society","doi-asserted-by":"crossref","award":["Retina Research Foundation Cox Family Foundation Grant"],"award-info":[{"award-number":["Retina Research Foundation Cox Family Foundation Grant"]}],"id":[{"id":"10.13039\/100013884","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Bayer","award":["Global Ophthalmology Awards Program"],"award-info":[{"award-number":["Global Ophthalmology Awards Program"]}]},{"DOI":"10.13039\/100004326","name":"Bayer","doi-asserted-by":"publisher","award":["Global Ophthalmology Awards Program"],"award-info":[{"award-number":["Global Ophthalmology Awards Program"]}],"id":[{"id":"10.13039\/100004326","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005426","name":"Association for Research in Vision and Ophthalmology","doi-asserted-by":"publisher","award":["Mallinckrodt Young Investigator Grant"],"award-info":[{"award-number":["Mallinckrodt Young Investigator Grant"]}],"id":[{"id":"10.13039\/100005426","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stanley M. Truhlsen Family Foundation"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Following the West African Ebola virus disease (EVD) outbreak of 2013\u20132016 and more recent EVD outbreaks in the Democratic Republic of Congo, thousands of EVD survivors are at-risk for sequelae including uveitis, which can lead to unremitting inflammation and vision loss from cataract. Because of the known risk of Ebola virus persistence in ocular fluid and the need to provide vision-restorative, safe cataract surgery, the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study was implemented in Sierra Leone. During implementation of this multi-national study, challenges included regulatory approvals, mobilization, community engagement, infection prevention and control, and collaboration between multiple disciplines. In this report, we address the multifacted approach to address these challenges and the impact of implementation science research to address an urgent clinical subspecialty need in an outbreak setting.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology\/Principal findings<\/jats:title>\n<jats:p>Given the patient care need to develop a protocol to evaluate ocular fluid for Ebola virus RNA persistence prior to cataract surgery, as well as protocols to provide reassurance to ophthalmologists caring for EVD survivors with cataracts, the EVICT study was designed and implemented through the work of the Ministry of Health, Sierra Leone National Eye Programme, and international partnerships. The EVICT study showed that all 50 patients who underwent ocular fluid sampling at 19 and 34 months, respectively, tested negative for Ebola virus RNA. Thirty-four patients underwent successful cataract surgery with visual acuity improvement. Here we describe the methodology for study implementation, challenges encountered, and key issues that impacted EVD vision care in the immediate aftermath of the EVD outbreak. Key aspects of the EVICT study included defining the pertinent questions and clinical need, partnership alignment with key stakeholders, community engagement with EVD survivor associations, in-country and international regulatory approvals, study site design for infection prevention and control, and thorough plans for EVD survivor follow-up care and monitoring. Challenges encountered included patient mobilization owing to transportation routes and distance of patients in rural districts. Strong in-country partnerships and multiple international organizations overcame these challenges so that lessons learned could be applied for future EVD outbreaks in West and Central Africa including EVD outbreaks that are ongoing in Guinea and Democratic Republic of Congo.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions\/Significance<\/jats:title>\n<jats:p>The EVICT Study showed that cataract surgery with a protocol-driven approach was safe and vision-restorative for EVD survivors, which provided guidance for EVD ophthalmic surgical care. Ophthalmologic care remains a key aspect of the public health response for EVD outbreaks but requires a meticulous, yet partnered approach with international and local in-country partners. Future efforts may build on this framework for clinical care and to improve our understanding of ophthalmic sequelae, develop treatment paradigms for EVD survivors, and strengthen vision health systems in resource-limited settings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252905","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T18:05:54Z","timestamp":1625853954000},"page":"e0252905","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone"],"prefix":"10.1371","volume":"16","author":[{"given":"Jessica G.","family":"Shantha","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Crozier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen S.","family":"Kraft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald G.","family":"Grant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine","family":"Goba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent R.","family":"Hayek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8259-2518","authenticated-orcid":true,"given":"Caleb","family":"Hartley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayla G.","family":"Barnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Uyeki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Schieffelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Garry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G.","family":"Bausch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E.","family":"Farmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.","family":"Mattia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"Vandy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5417-7771","authenticated-orcid":true,"given":"Steven","family":"Yeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EVICT Study Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"pone.0252905.ref001","unstructured":"World Health Organization. World Health Organization Ebola Situation Report 2016. 2016. https:\/\/www.who.int\/csr\/disease\/ebola\/situation-reports\/archive\/en\/."},{"key":"pone.0252905.ref002","unstructured":"World Health Organization. Ebola virus disease. 2020. http:\/\/www.who.int\/news-room\/fact-sheets\/detail\/ebola-virus-disease."},{"key":"pone.0252905.ref003","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1056\/NEJMoa1805435","article-title":"A Longitudinal Study of Ebola Sequelae in Liberia","volume":"380","author":"PREVAIL III Study Group","year":"2019","journal-title":"N Engl J Med"},{"key":"pone.0252905.ref004","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.ophtha.2016.10.011","article-title":"Ophthalmic Manifestations and Causes of Vision Impairment in Ebola Virus Disease Survivors in Monrovia, Liberia","author":"JG Shantha","year":"2017","journal-title":"Ophthalmology"},{"key":"pone.0252905.ref005","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1080\/09273948.2018.1484493","article-title":"Clinical Manifestations and Pathogenesis of Uveitis in Ebola Virus Disease Survivors","volume":"26","author":"S Yeh","year":"2018","journal-title":"Ocul Immunol Inflamm"},{"key":"pone.0252905.ref006","article-title":"Persistence of ebola virus in ocular fluid during convalescence","author":"JB Varkey","year":"2015","journal-title":"N Engl J Med"},{"key":"pone.0252905.ref007","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1056\/NEJMoa1511410","article-title":"Ebola RNA Persistence in Semen of Ebola Virus Disease Survivors\u2014Final Report","volume":"377","author":"GF Deen","year":"2017","journal-title":"N Engl J Med"},{"key":"pone.0252905.ref008","unstructured":"World Health Organization. Ebola Virus Disease Democratic Republic of Congo: External Situation Report 76\/2019. 2020. https:\/\/www.who.int\/publications-detail\/ebola-virus-disease-democratic-republic-of-congo-external-situation-report-76-2019."},{"key":"pone.0252905.ref009","unstructured":"First FDA-approved vaccine for the prevention of Ebola virus disease, marking a critical milestone in public health preparedness and response. www.fda.gov. December 19, 2019."},{"key":"pone.0252905.ref010","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1056\/NEJMoa1910993","article-title":"A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics","volume":"381","author":"S Mulangu","year":"2019","journal-title":"N Engl J Med"},{"key":"pone.0252905.ref011","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/S0140-6736(16)32621-6","article-title":"Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola \u00c7a Suffit!)","volume":"389","author":"AM Henao-Restrepo","year":"2017","journal-title":"Lancet"},{"key":"pone.0252905.ref012","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/S1473-3099(16)00077-3","article-title":"Sequelae of Ebola virus disease: the emergency within the emergency","volume":"16","author":"P Vetter","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"pone.0252905.ref013","article-title":"Early clinical sequelae of Ebola virus disease in Sierra Leone: A cross-sectional study","author":"JG Mattia","year":"2016","journal-title":"Lancet Infect Dis"},{"key":"pone.0252905.ref014","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ajo.2016.12.005","article-title":"Ocular Complications in Survivors of the Ebola Outbreak in Guinea","volume":"175","author":"E Hereth-Hebert","year":"2017","journal-title":"Am J Ophthalmol"},{"key":"pone.0252905.ref015","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ebiom.2018.03.020","article-title":"Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study: Reverse Transcription-Polymerase Chain Reaction and Cataract Surgery Outcomes of Ebola Survivors in Sierra Leone","volume":"30","author":"JG Shantha","year":"2018","journal-title":"EBioMedicine"},{"issue":"Suppl","key":"pone.0252905.ref016","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1093\/infdis\/jiv359","article-title":"Ebola Virus: Sensationalism, Science, and Human Rights","volume":"212","author":"DG Bausch","year":"2015","journal-title":"J Infect Dis"},{"key":"pone.0252905.ref017","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1001\/jamaophthalmol.2019.1936","article-title":"Insights From 2 Outbreaks in Southeastern Brazil","volume":"137","author":"JG Shantha","year":"2019","journal-title":"JAMA Ophthalmol"},{"key":"pone.0252905.ref018","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s40249-018-0468-6","article-title":"Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study","volume":"7","author":"Y Li","year":"2018","journal-title":"Infect Dis poverty"},{"key":"pone.0252905.ref019","doi-asserted-by":"crossref","first-page":"S153","DOI":"10.1093\/infdis\/jiw345","article-title":"Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone","volume":"214","author":"C Cancedda","year":"2016","journal-title":"J Infect Dis"},{"key":"pone.0252905.ref020","article-title":"Burden, timing, and outcomes of uveitis from a retrospective cohort of Ebola survivors in Sierra Leone","author":"MJ Vandy","year":"2018","journal-title":"Investig Ophthalmol Vis Sci"},{"key":"pone.0252905.ref021","unstructured":"World Health Organization. Clinical management of patients with viral hemorrhagic fever: a pocket guide for front-line health workers. 2016."},{"key":"pone.0252905.ref022","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1126\/science.1259657","article-title":"Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak","volume":"345","author":"SK Gire","year":"2014","journal-title":"Science"},{"key":"pone.0252905.ref023","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3928\/01913913-20080901-16","article-title":"Cataract surgery in pediatric uveitis","volume":"45","author":"AG Zaborowski","year":"2008","journal-title":"J Pediatr Ophthalmol Strabismus"},{"key":"pone.0252905.ref024","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/j.jcrs.2014.10.034","article-title":"Posterior capsule opacification in pediatric eyes with and without traumatic cataract","volume":"41","author":"RH Trivedi","year":"2015","journal-title":"J Cataract Refract Surg"},{"key":"pone.0252905.ref025","first-page":"1012","volume-title":"Association for Research in VIsion and Ophthalmology","author":"R Bishop","year":"2019"},{"issue":"1","key":"pone.0252905.ref026","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1167\/tvst.10.1.32","article-title":"Efficacy and safety outcomes of cataract surgery in survivors of Ebola virus disease: 12-month results from the PREVAIL VII Study","volume":"10","author":"AO Eghrari","year":"2021","journal-title":"Trans Vis Sci Technol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252905","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T18:06:28Z","timestamp":1625853988000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0252905"}},"subtitle":[],"editor":[{"given":"Shree K.","family":"Kurup","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,9]]},"references-count":26,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0252905","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,9]]}}}