Towards elimination: Challenges in community participation to a gHAT 'screen and treat' strategy using the new oral drug acoziborole in the Democratic Republic of the Congo.

Until recently, treatment options for gambiense human African trypanosomiasis (gHAT) have been limited and toxic, negatively impacting community participation to screening and treatment. A new, non-toxic, single-dose oral drug has shown efficacy in a Phase III trial and is being tested in a trial called 'STROGHAT', which aims to demonstrate cessation of HAT transmission using a 'screen and treat' strategy. This study aims to explore community perceptions about current and future screening and treatment strategies and identify what could act as barriers to participation in order to prevent them. We conducted 8 focus group discussions and 18 semi-structured interviews with communities, community leaders and mobile unit managers in 4 selected villages out of 74 endemic villages included in the STROGHAT study. Our results highlight four main potential barriers: the rarity of cases has led to gHAT being perceived as a disease that no longer exists and participation to screening as a waste of time. Lack of awareness of new treatment and screening procedures perpetuates fears and misconceptions about treatment toxicity, lumbar puncture and mandatory hospitalisation. The introduction of a single-dose oral drug to be administered on the spot raised the issue of side effect monitoring and care. Finally, the lack of sensitivity to community cultural norms in the organisation of screening discourages people from participating. Those barriers are important to anticipate and include in elimination strategy. Also a monitor perception about acoziborole screen and treat during all the process through other social science based research is to foreseen.