Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo
Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo
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DOI：
10.1111/j.1365-3156.2006.01768.x
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发表时间：
2007-02-01
影响因子：
3.3
通讯作者：
Boelaert, M.
中科院分区：
文献类型：
--
作者：
Robays, J.;Lefevre, P.;Boelaert, M.
由流动小组开展的积极病例发现规划是西非人非洲锥虫病控制的基石。筛查出勤率低和诊断后接受治疗率低是主要问题。本调查的目的是探讨社区对HAT的看法，评估控制活动的可接受性，并确定可干预的障碍。方法2004年9月，我们在刚果民主共和国的两个生态环境（大草原和河流）中，与HAT控制方案的各族裔受益人进行了33次焦点小组讨论。结果人群对HAT的传播、筛查的效用、症状和治疗有非常详细的认识和了解。人们担心美拉胂醇治疗有副作用。以前无症状的人在治疗期间突然死亡被归咎于巫术，当诊断结果被公开后，人们变得更容易受到巫术的伤害。缺乏保密性也是一个问题，因为HAT作为一种精神疾病带有耻辱。腰椎穿刺，尤其是在公共场合进行时，虽然不受欢迎，但不那么令人害怕。经济障碍是许多患者面临的主要障碍。结论降低药物毒性、降低资金障碍和提高保密水平对参与HAT人群筛查有重要影响。
Introduction Active case-finding programmes by mobile teams are the cornerstone of West African Human African Trypanosomiasis (HAT) control. Low attendance rates of screening and low uptake of treatment after diagnosis are major problems. The objectives of this survey were to explore community perception of HAT, to assess acceptability of control activities and to identify barriers amenable to intervention.Methods In September 2004, we conducted 33 focus group discussions with beneficiaries of the HAT control programme among various ethnic groups in two ecological settings (savannah and fluvial) of the Democratic Republic of Congo.Results The population had a very detailed knowledge and understanding of HAT transmission, utility of screening, symptoms and treatment. Melarsoprol treatment was feared for its side effects. The sudden death of previously asymptomatic people during treatment was attributed to witchcraft, to which one becomes more vulnerable when the diagnosis is disclosed in public. Lack of confidentiality was also a problem because HAT carries a stigma as a mental disease. Lumbar punctures, especially when performed in public, were disliked but less feared. Financial barriers were a major obstacle for many patients.Conclusions Less toxic drugs, lowering financial barriers and improving confidentiality would have considerable impact on the participation in population screening for HAT.