title: Barriers to Linkage to Care for Hepatitis B Virus Infection: A Qualitative Analysis in Burkina Faso, West Africa.
abstract: Hepatitis B virus (HBV) infection is a critical global health problem. The World Health Organization (WHO) has recently developed a global elimination strategy for HBV infection. Increasing access to screening, liver assessment, and antiviral treatment are crucial steps in achieving this goal. Little is known, however, about obstacles to linkage to care in low- and middle-income countries. Using a grounded theory approach, this qualitative study sought to characterize the diagnostic itineraries of people with chronic HBV infection in Burkina Faso, a west African country with high HBV prevalence, to identify barriers to linkage from screening to specialist care with hepatic assessment (alanine transaminase and hepatitis B e antigen or HBV DNA). We conducted 80 semistructured interviews with chronically infected people, their families, medical personnel, and traditional practitioners, and participant observation of HBV diagnostic announcements and consultations. Of 30 individuals diagnosed with chronic viral hepatitis, 18 inadvertently discovered their status through blood screening and 12 actively sought diagnosis for their symptoms. Only a quarter (8/30) were linked to care. Barriers included: 1) patients' ability to pay for testing and treatment; 2) a formal health system lacking trained personnel, diagnostic infrastructures, and other resources; 3) patients' familial and social networks that discouraged access to testing and HBV knowledge; 4) a well-developed demand for and provisioning of traditional medicine for hepatitis; and 5) a weak global politics around HBV. More training for medical personnel would improve linkage to care in sub-Saharan Africa. Developing effective communications between medical workers and patients should be a major priority in this elimination strategy.
authors.affiliation: Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France. tamara.giles-vernick@pasteur.fr.
authors.forename: Tamara
authors.initials: T
authors.lastname: Giles-Vernick
authors.affiliation: Unité Mixte Internationale (UMI) 233/U1175 TransVIH, Institut de Recherche pour le Développement/Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France.|Centre de Recherche sur les Médiations, Université de Lorraine, Metz, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Hejoaka
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Armande
authors.initials: A
authors.lastname: Sanou
authors.affiliation: Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimakawa
authors.affiliation: Sciences de l'Homme Appliquées au Développement et à l'Evaluation des Interventions (SHADEI), Centre Muraz, Bobo-Dioulasso, Burkina Faso.
authors.forename: Issiaka
authors.initials: I
authors.lastname: Bamba
authors.affiliation: Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Traoré
mesh_terms: D000328:Adult; D002050:Burkina Faso / Q000453:epidemiology; D003906:Developing Countries; D006297:Health Services Accessibility; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011203:Poverty; D055815:Young Adult