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Author: search.filters.author.Osborne, AugustusStart date: 2025

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    Community-driven responses to the Kush epidemic and health system resilience in Kailahun District Sierra Leone
    (2026-08-07) Osborne, Augustus
    Sierra Leone faces an escalating public health emergency driven by “Kush,” a locally available psychoactive substance often comprising a toxic mix of cannabis and synthetic adulterants. Its variable, often toxic composition and rapid proliferation among youth amplify public health risks. In Kailahun District, a rural border region with limited mental health infrastructure, health and social systems are under immense pressure to respond to rising demand amid chronic resource constraints, centralized service delivery, and fragmented care pathways. This study examined the community-driven responses to the Kush epidemic in Kailahun, Sierra Leone. We conducted a qualitative, exploratory study in Kailahun District between July and August 2025 to examine local system resilience. Using purposive and maximum-variation sampling, we engaged 10 diverse stakeholders, including frontline health workers, district managers, police officers, chiefs, youth leaders, teachers, and faith actors. Data were collected via semi-structured key informant interviews and focus group discussions, conducted in English or Krio, and analyzed thematically using a health systems resilience framework. This approach allowed us to map local responses, barriers, and community-identified priorities across absorptive, adaptive, and transformative capacities. Ethical approval was obtained from the Sierra Leone Ethics Review Scientific Committee. Thematic analysis revealed four interlinked themes mapped to health systems resilience capacities. First, structural determinants including unemployment, poverty, and post-conflict insecurity act as cross-cutting contextual constraints that drive Kush use and strain caregiving systems. Second, reactive clinical responsiveness and frontline ingenuity reflect absorptive capacity at the point of acute crisis, despite chronic medicine stockouts and bed shortages. Third, multiple barriers to adaptive responses including limited mental health expertise, high staff turnover, geographic centralization of services, policy ambiguity, and fragmented intersectoral coordination constrain the system’s ability to evolve beyond crisis management. Fourth, community and faith-based mobilization demonstrate latent adaptive and transformative potential, currently limited by the absence of formal integration, financing, and referral linkages. Stakeholders consistently prioritized decentralized outreach, sustained multi-sector training, reliable medicine supplies, coherent drug policy, structured rehabilitation pathways, and livelihood support as actionable priorities. Tackling the Kush epidemic demands integrated, district-level strategies that merge clinical interventions with social and economic supports. A recovery-oriented system, underpinned by pragmatic governance, interoperable data systems, and formalized community engagement, offers a sustainable pathway to impact in Sierra Leone and comparable low-resource settings facing similar substance use crises.
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    Advancing Toward the UNAIDS 95‑95‑95 Targets in Sierra Leone: A Narrative Review of Progress, Persistent Gaps, and Policy Priorities
    (Elsevier BV, 2026-03-25) Osborne, Augustus; Osborne, Augustus
    **Background:** Sierra Leone, with a low adult HIV prevalence (\~1.6–1.7%), faces uneven progress toward the UNAIDS 95‑95‑95 targets, with significant gaps in diagnosis, viral load (VL) coverage, and key population reach. **Methods:** A narrative review (January 2013–June 2024; final search 30 June 2024) synthesized national reports and peer‑reviewed articles on Sierra Leone’s HIV cascade and systemic determinants. Data focused on diagnosis, treatment, suppression, and cross‑cutting issues (e.g., stigma, supply chain). **Results:** In 2023, of an estimated 82,000 people living with HIV (PLHIV), 80% (65,600) were diagnosed. Of those diagnosed, 87% (57,072) were on antiretroviral therapy (ART), and 44% of those on ART (25,112) were virally suppressed. VL testing covered 68% of ART patients (38,812), suggesting incomplete coverage may underestimate true population‑level suppression if untested patients are less likely to be suppressed. Key bottlenecks include limited VL platforms, commodity stockouts of antiretrovirals, stigma (especially for female sex workers), adolescent retention gaps, absent drug resistance surveillance, fragmented data systems, and donor‑dependent financing. **Conclusions:** Progress is tangible but fragile. Prioritizing detection (first 95) through scaled testing, alongside VL network strengthening, differentiated service delivery (e.g., six‑month multi‑month dispensing), stigma monitoring, drug resistance surveillance, and sustainable financing roadmaps, is essential. Targeted research on implementation and cost‑effectiveness will support equitable attainment of HIV 2030 goals.