title: [Perception of pain by patients receiving antiretroviral treatment in North Kivu, DR Congo].
abstract: This operational research conducted among TB patients co-infected with HIV in North Kivu had three objectives: (i) to clarify the local perception of a certain type of pain (michi in the local language) in patients on antiretroviral treatment (ART); (ii) to identify the attitudes of health care personnel regarding the management of ART side effects; and (iii) to explore ways to improve the quality of life of patients on ART and provide them with pain relief. Twenty in-depth interviews were conducted with patients on ART and their medical care providers in district health centers of North-Kivu and at patients' homes. A semantic analysis of the term michi revealed a nosologic folk entity based on a naturalistic view of the body; the term michi is used to name: (i) the "roots" of plants or trees; (ii) channels (veins, arteries, but also nerves and tendons) in the body through which fluids (blood, water) and energy are conveyed; (iii) different types of acute pain, possibly located along these channels. The description (location, duration, and intensity) of the functional signs and the context of their occurrence (while taking Stavudine) confirmed the medical diagnosis of acute sensory neuropathies. Although a classic ART side effect, neuropathies are underdiagnosed by health workers who find it difficult to recognize signs of treatment toxicity in apparently trivial symptoms. Different reasons account for this: (i) healthcare staff have little time to spend with TB/HIV patients and thus provide inadequate management of functional symptoms; (ii) insufficient attention is paid to patients' acute pain, which is often perceived as "normal"; (iii) insufficient knowledge of ART side effects due to staff turnover higher than the frequency of training that programmes. The study was conducted as part of the DR Congo national programmes for TB and AIDS and led to the formulation of recommendations about improving, especially through training, the assessment of functional symptoms as expressed in the main cultural areas of the country, including increased awareness of their vernacular expressions. This study also stressed the need for early diagnosis and management of iatrogenic neuropathy. The integration of leprosy and TB programmes in DR Congo in principle offers a suitable framework to develop synergies for the management of peripheral neuropathy. Finally, providing increased attention to patients (empathy, listening and counselling) requires time and calls for a careful analysis of the care providers' workload, to facilitate the smooth integration of HIV care into general health services.
authors.affiliation: Les Bleuets 556, route du Château 01280 Moens France, Ministère de la Santé Inspection provinciale de la santé Goma Nord-Kivu RD Congo, Ministère de la santé s/c Inspection Provinciale de la Santé Goma Nord Kivu RD Congo, Ministère de la Santé Bureau national de la tuberculose BP 12706 Kinshasa RD Congo, Alter santé internationale et développement 1, rue Henri 34090 Montpellier France, Union internationale contre la tuberculose et les maladies respiratoires Département VIH 68, Boulevard Saint Michel 75006 Paris France.
authors.forename: Claire
authors.initials: C
authors.lastname: Escoffier
authors.forename: Alain
authors.initials: A
authors.lastname: Kambale
authors.forename: Faustin
authors.initials: F
authors.lastname: Paluku
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Kabuayi
authors.forename: François
authors.initials: F
authors.lastname: Boillot
mesh_terms: D003223:Congo; D015658:HIV Infections; D006801:Humans; D010146:Pain; D010465:Perception; D011788:Quality of Life; D014376:Tuberculosis