{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T18:47:16Z","timestamp":1776451636326,"version":"3.51.2"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014179","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000}}],"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The control of human African trypanosomiasis (HAT) relies primarily on the early detection and appropriate treatment of cases, which remain central components of current elimination strategies, while no vaccine or chemoprophylaxis is available. However, under-screening by mobile units is observed. Low HAT prevalence may lower motivation to participate in active screening programs that are important for early detection of cases, because people do not perceive the risk of infection. In this context, the integration of passive HAT screening into primary health services is encouraged but faces multiple challenges. This study aimed to explore the opinions and perceptions of the different actors involved in the integration of passive HAT screening into first level health establishments (Health Center and General Referral Hospital) in Bibanga Health District and identify the potential obstacles likely to affect it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study was conducted in four health areas, selected based on their performance in reporting passive screening (PS) activities and their geographical distance from the Central District Office. Thirteen focus group discussions (FGDs) were held with men, women, and young people, as well as twelve semi-structured interviews (SSIs) with former HAT patients, community volunteers (Presidents of the Health Committee), healthcare providers, and local and provincial decision-makers. The discussions were digitally recorded, transcribed, translated from Tshiluba into French, and thematically analyzed using ATLAS.ti 7.5.16 software. A documentary review was also carried out to complement the empirical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Community perceptions indicate a limited knowledge about HAT, especially among young people, with confusion between HAT and malaria, fear of testing, and persistent rumors. Women expressed feelings of marginalization due to a lack of targeted information. On the provider side, demotivation is evident, linked to the absence of passive screening integration into official policies, lack of training, and lack of recognition. Community volunteer complained of a lack of support and motivation. The identified obstacles include: (i) structural barriers (geographical accessibility, stockouts, low attendance), (ii) economic constraints (medical expenses, transportation costs), (iii) sociocultural barriers (rumors, stigmatization), and (iv) institutional limitations (lack of supervision, low community involvement). Perception gaps have been noted between field actors and health authorities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The integration of passive screening into primary healthcare programs requires a multisectoral approach tailored to the local context. Simplifying the diagnostic process would facilitate integration. However, the healthcare system must be adequately funded and equipped. These results offer concrete pathways to enhance the integration of passive screening and contribute to the elimination of HAT by 2030.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014179","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T17:46:06Z","timestamp":1775670366000},"page":"e0014179","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers to integration of passive screening for sleeping sickness in Bibanga Health District, Democratic Republic of the Congo"],"prefix":"10.1371","volume":"20","author":[{"given":"J\u00e9r\u00e9mie","family":"Ilunga","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Mulenga-Cilundika","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6998-0540","authenticated-orcid":true,"given":"Jo\u00ebl","family":"Ekofo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isra\u00ebl","family":"Badypwyla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julienne","family":"Tshowa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Ishoso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c9ric","family":"Mwamba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilbert","family":"Wembodinga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"pntd.0014179.ref001","volume-title":"Human African trypanosomiasis (sleeping sickness)","author":"World Health Organization (WHO)","year":"2023"},{"issue":"10482","key":"pntd.0014179.ref002","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S0140-6736(25)00107-2","article-title":"Human African trypanosomiasis","volume":"405","author":"V Lejon","year":"2025","journal-title":"Lancet"},{"key":"pntd.0014179.ref003","first-page":"1","article-title":"Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda \u2013 Moving towards elimination","author":"NMC Wamboga","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014179.ref004","unstructured":"Camara O, Courtin F, Dramane K. Evolution of strategies to combat human African latrypanosomiasis in a context of epidemiological transition. 2020."},{"key":"pntd.0014179.ref005","unstructured":"WHO. Driving elimination of human African trypanosomiasis (THA) in a challenging transboundary region in line with SDG 3 and SDG target 3.3. World Heal Organ [Internet]. 2021;(984). Available from: https:\/\/sustainabledevelopment.un.org\/partnership\/?p=30104"},{"key":"pntd.0014179.ref006","unstructured":"WHO. Human African trypanosomiasis (sleeping sickness) [Internet]. 2021 [Accessed: 17-10-2021]. Available from: http:\/\/www.agencesss04.qc.ca\/sante-publique\/entreprises-infectieuses\/entreprises-du-hamburger.html"},{"issue":"5","key":"pntd.0014179.ref007","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1046\/j.1365-3156.2001.00669.x","article-title":"Sleeping sickness surveillance: an essential step towards elimination","volume":"6","author":"P Cattand","year":"2001","journal-title":"Trop Med Int Health"},{"key":"pntd.0014179.ref008","volume-title":"Sleeping Sickness Elimination Agenda: Building a Global Alliance","author":"WHO","year":"2002"},{"key":"pntd.0014179.ref009","unstructured":"WHO. Report from the third WHO stakeholders meeting on elimination of gambiense human African trypanosomiasis. April 18-20, 2018. Vol. 12, PLoS Neglected Tropical Diseases. 2018."},{"issue":"2","key":"pntd.0014179.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.0050055","article-title":"Eliminating human African trypanosomiasis: where do we stand and what comes next?","volume":"5","author":"PP Simarro","year":"2008","journal-title":"PLoS Med"},{"issue":"2","key":"pntd.0014179.ref011","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(19)30612-7","article-title":"New WHO guidelines for treatment of gambiense human African trypanosomiasis including fexinidazole: substantial changes for clinical practice","volume":"20","author":"AK Lindner","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"pntd.0014179.ref012","unstructured":"WHO. The Global Health Observatory: Human African trypanosomiasis (sleeping sickness) [Internet]. 2021 [cited 2021 Nov 22]. Available from: https:\/\/www.who.int\/data\/gho\/data\/themes\/topics\/human-african-trypanosomiasis"},{"key":"pntd.0014179.ref013","first-page":"1","volume-title":"Declaration of the policy to combat human African trypanosomiasis in the Democratic Republic of Congo","author":"PNLTHA","year":"2015"},{"issue":"1","key":"pntd.0014179.ref014","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/tmi.12404","article-title":"Integration of diagnosis and treatment of sleeping sickness in primary healthcare facilities in the Democratic Republic of the Congo","volume":"20","author":"P Mitashi","year":"2015","journal-title":"Trop Med Int Health"},{"issue":"4","key":"pntd.0014179.ref015","doi-asserted-by":"crossref","first-page":"899","DOI":"10.4269\/ajtmh.18-0382","article-title":"Integration of Human African Trypanosomiasis Control Activities into Primary Health Services in the Democratic Republic of the Congo: A Qualitative Study of Stakeholder Perceptions","volume":"100","author":"P Mulenga","year":"2019","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pntd.0014179.ref016","first-page":"1","article-title":"Whose elimination? Frontline workers\u2019 perspectives on the elimination of the human African trypanosomiasis and its anticipated consequences","volume":"5","author":"JB Falisse","year":"2020","journal-title":"Trop Med Infect Dis"},{"key":"pntd.0014179.ref017","unstructured":"Mulenga Cilundika P. \u201cContribution of primary health care services to the control of Human African Trypanosomiasis in the context of its elimination in the Democratic Republic of Congo\u201d. Free University of Brussels (ULB). 2020 [Online]. Available from: https:\/\/www.itg.be\/F\/Evenement\/phd-defence-philippe-mulenga"},{"issue":"3","key":"pntd.0014179.ref018","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/trstmh\/trv111","article-title":"Addressing diabetes mellitus as part of the strategy for ending TB","volume":"110","author":"AD Harries","year":"2015","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0014179.ref019","unstructured":"WHO. Framework for integrated, person-centered health services. Secretariat report [Internet]. 2016;(December):1\u201313. Available from: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA69\/A69_39-fr.pdf?ua=1"},{"issue":"4","key":"pntd.0014179.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006276","article-title":"The impact of passive case detection on the transmission dynamics of gambiense Human African Trypanosomiasis","volume":"12","author":"F Checchi","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014179.ref021","unstructured":"Mpanya A. Sociocultural factors and control of human African trypanosomiasis in the Democratic Republic of Congo. Univ Libr Brussels (ULB). 2015;Thesis:169."},{"key":"pntd.0014179.ref022","first-page":"1","article-title":"Complementarity \u201cPassive detection - Active detection\u201d with a view to eliminating sleeping sickness in DR Congo: a necessity now more than ever","author":"P Mulenga","year":"2020","journal-title":"Note Polit"},{"issue":"5","key":"pntd.0014179.ref023","first-page":"447","article-title":"Medicine and health in the Democratic Republic of Congo: from Independence to the Third Republic","volume":"67","author":"S Wembonyama","year":"2007","journal-title":"Med Trop (Mars)"},{"issue":"3","key":"pntd.0014179.ref024","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s40121-019-0253-2","article-title":"Passive screening and diagnosis of sleeping sickness with new tools in primary health services: an operational research","volume":"8","author":"P Mulenga","year":"2019","journal-title":"Infect Dis Ther"},{"key":"pntd.0014179.ref025","unstructured":"Contandriopoulos A.P, Denis J.L, Touati N, Rodriguez R. Integration of care: dimensions and implementation Integration of care: dimensions and implementation | Andr\u00e9-Pierre Contandriopoulos - Academia.edu. 2001."},{"key":"pntd.0014179.ref026","unstructured":"WHO. Human African trypanosomiasis: control and surveillance. Rapp Series. Tech. WHO, vol. 984, no. Technical report of the WHO expert committee on Human African Trypanosomiasis. 2013. 270 p."},{"key":"pntd.0014179.ref027","doi-asserted-by":"crossref","unstructured":"Mpanya A, Mitashi P, Luboya O, Kande V, Boelaert M, Lefe P. Should I get screened for sleeping sickness? A qualitative study in Kasai province, Democratic Republic of Congo. 2012;6(1):5\u20137.","DOI":"10.1371\/journal.pntd.0001467"},{"key":"pntd.0014179.ref028"},{"key":"pntd.0014179.ref029"},{"key":"pntd.0014179.ref030","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.actatropica.2016.05.009","article-title":"Facteurs influen\u00e7ant la surveillance passive de la trypanosomiase humaine africaine \u00e0 T. b. rhodesiense en Ouganda","volume":"165","author":"C Acup","year":"2017","journal-title":"Acta Trop"},{"key":"pntd.0014179.ref031"},{"key":"pntd.0014179.ref032"},{"key":"pntd.0014179.ref033","unstructured":"Nkwahata R, Tabibi B, Nsungu E, Buhendwa E. Facteurs de d\u00e9motivation des prestataires de la zone de sant\u00e9 de kenge dans le contexte du financement bas\u00e9 sur la performance. 2023. https:\/\/doi.org\/10.5281\/zenodo.7849969"},{"issue":"3","key":"pntd.0014179.ref034","first-page":"215","article-title":"La trypanosomiase humaine africaine: perspective pour son \u00e9limination comme probl\u00e8me de sant\u00e9 publique en RDC","volume":"7","author":"J Robays","year":"2016","journal-title":"Rev Med Afr Cent"},{"issue":"4","key":"pntd.0014179.ref035","first-page":"553","article-title":"D\u00e9fis de l\u2019int\u00e9gration des maladies tropicales n\u00e9glig\u00e9es dans les syst\u00e8mes de sant\u00e9 en Afrique de l\u2019Ouest","volume":"32","author":"M Koffi","year":"2020","journal-title":"Sant\u00e9 Publique"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0014179","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T18:00:24Z","timestamp":1776448824000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014179"}},"subtitle":[],"editor":[{"given":"Amy C.","family":"Morrison","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014179","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]}}}