Partners in Health, Rwinkwavu, Rwanda.
Rwanda Military Hospital, Kanombe, Rwanda.
Glob Public Health. 2020 Dec;15(12):1778-1788. doi: 10.1080/17441692.2020.1801787. Epub 2020 Jul 31.
An estimated 71 million people live with hepatitis C virus (HCV) and without an effective vaccination, control efforts depend entirely on prevention, early diagnosis, and treatment with direct acting antiviral medication. The experiences of accessing care and treatment, as well as how HCV is locally perceived, are context specific and require an understanding of local epidemics. The objectives of this study were to explore the experiences and demand-side barriers for people with chronic HCV infection, as well as describe the social and cultural landscapes in which they experienced, managed, and perceived HCV in Rwanda. Eleven participants provided consent to participate and all completed two semi-structured interviews during treatment within a clinical trial. We identified four themes: (1) diagnosis and use of traditional medicine, (2) access and financial barriers, (3) complex social networks (4) proactivity in care-seeking. Results demonstrate the complex ways in which Rwandans understand HCV, utilise parallel health systems, activate social networks, and the importance of active agency in the opportunities and outcomes for their own health in the context of an early response to a major epidemic. Without recognising communities' understanding and expectations, it is impossible to build a sustainable and successful public health response to HCV.
据估计，全球有 7100 万人感染丙型肝炎病毒（HCV），且没有有效的疫苗，因此控制工作完全依赖于预防、早期诊断和使用直接作用抗病毒药物进行治疗。获取医疗服务和治疗的体验，以及当地对 HCV 的认知，都是特定背景下的情况，需要了解当地的流行情况。本研究的目的是探讨慢性 HCV 感染者的体验和需求方障碍，并描述他们在卢旺达经历、管理和感知 HCV 的社会和文化背景。11 名参与者同意参与，并在临床试验中的治疗期间完成了两次半结构化访谈。我们确定了四个主题：（1）诊断和使用传统医学，（2）获取和财务障碍，（3）复杂的社交网络，（4）主动寻求护理。研究结果表明，卢旺达人理解 HCV、利用平行卫生系统、激活社交网络的方式非常复杂，以及在重大疫情早期应对背景下，积极主动在自身健康的机会和结果中具有重要意义。如果不了解社区的理解和期望，就不可能建立可持续和成功的 HCV 公共卫生应对措施。
