Mulenga Philippe, Lutumba Pascal, Coppieters Yves, Mpanya Alain, Mwamba-Miaka Eric, Luboya Oscar, Chenge Faustin
Faculty of Medicine & School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Infect Dis Ther. 2019 Sep;8(3):353-367. doi: 10.1007/s40121-019-0253-2. Epub 2019 Jul 15.
The integration of human African trypanosomiasis (HAT) activities into primary health services is gaining importance as a result of the decreasing incidence of HAT and the ongoing developments of new screening and diagnostic tools. In the Democratic Republic of Congo, this integration process faces multiple challenges. We initiated an operational research project to document drivers and bottlenecks of the process.
Three health districts piloted the integration of HAT screening and diagnosis into primary health services. We analysed the outcome indicators of this intervention and conducted in-depth interviews with health care providers, seropositives, community health workers and HD management team members. Our thematic interview guide focused on factors facilitating and impeding the integration of HAT screening.
The study showed a HAT-RDT-positive rate of 2.2% in Yasa Bonga, 2.9% in Kongolo and 3% in Bibanga, while the proportion of reported seropositives that received confirmatory examinations was 76%, 45.6% and 68%, respectively. Qualitative analyses indicated that some seropositives were unable to access the confirmation facility. The main reasons that were given included distance, RDT rupture, lack of basic screening equipment and financial barriers (additional hospital fees not included in free treatment course), fear of lumbar puncture and the perception of HAT as a disease of supernatural origin.
Passive screening using HAT RDTs in primary health services inevitably has some limitations. However, regarding the epidemiological context and some obstacles to integrated implementation, this cannot on its own be a relevant alternative to the elimination of HAT by 2020.
We acknowledge the agency that provided financial support for this study, the Belgian Development Cooperation. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Philippe Mulenga received financial support thanks to a doctoral grant from the Belgian Development Cooperation under the FA4 agreement. Funding for the study and Rapid Service Fees was provided by the Epidemiology and Tropical Diseases Unit of the Institute of Tropical Medicine, Antwerp.
由于人类非洲锥虫病（HAT）发病率不断下降以及新筛查和诊断工具的持续发展，将HAT活动纳入初级卫生服务变得愈发重要。在刚果民主共和国，这一整合过程面临多重挑战。我们启动了一项运筹学项目，以记录该过程的驱动因素和瓶颈。
三个卫生区试点将HAT筛查和诊断纳入初级卫生服务。我们分析了该干预措施的结果指标，并对医疗服务提供者、血清学阳性者、社区卫生工作者和卫生区管理团队成员进行了深入访谈。我们的主题访谈指南聚焦于促进和阻碍HAT筛查整合的因素。
研究显示，亚萨邦加的HAT快速诊断检测（RDT）阳性率为2.2%，孔戈洛为2.9%，比班加为3%，而接受确诊检查的报告血清学阳性者比例分别为76%、45.6%和68%。定性分析表明，一些血清学阳性者无法获得确诊设施。给出的主要原因包括距离、RDT破裂、缺乏基本筛查设备和经济障碍（免费治疗疗程中未包括额外的医院费用）、对腰椎穿刺的恐惧以及将HAT视为超自然起源疾病的观念。
在初级卫生服务中使用HAT RDT进行被动筛查不可避免地存在一些局限性。然而，考虑到流行病学背景和综合实施的一些障碍，这本身并不能成为到2020年消除HAT的相关替代方案。
我们感谢为该研究提供资金支持的机构，即比利时发展合作署。资助者在研究设计、数据收集和分析、决定发表或稿件准备过程中没有任何作用。菲利普·穆伦加得益于比利时发展合作署根据FA4协议提供的博士奖学金而获得资金支持。该研究及快速服务费的资金由安特卫普热带医学研究所的流行病学和热带病科提供。
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