{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T07:23:49Z","timestamp":1790753029621,"version":"4.1.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T00:00:00Z","timestamp":1618185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Only a fraction of the estimated tenth or so of Senegalese who are chronically infected with hepatitis B virus (HBV) have been diagnosed. Of these, few have been assessed for their risk of progressing to potentially fatal liver disease (indicating need for treatment), and fewer still are taking antiviral drugs. A massive gap between those needing and getting treatment is widely acknowledged among experts. But given that HBV and its biomedical treatment options are largely invisible in bodies, health data, care practices, public messaging, or mass media, how can we observe, ethnographically, the effects of constraints on and inequalities in treatment? What are the stakes of access to drugs, when this access is not being sought out, claimed, or enacted? This article tackles these questions by examining how HBV is being enacted in Senegal, but not necessarily in relation to antiviral treatment. I first describe the emergence, over the past decade and a half, of an exclusionary topography of HBV diagnosis and treatment. I introduce the notion of \u201cfiltration\u201d to describe the effects of this topography on the formation of potential \u201csubjects of access.\u201d The diagnostic therapies and expertise required to determine need for treatment are expensive, urban, and largely privatized. Moreover, knowledge about HBV and its possibilities of care circulates in narrow and sparsely distributed channels. Only a tiny minority of persons are effectively \u201cfiltered into\u201d care, while issues of access remain largely outside of public debate. I then move onto small-scale efforts, led by rural primary health workers and community associations, to raise awareness of and expand screening for HBV. Those driving information and screening either do not reveal that effective drugs exist or locate these beyond the reach of most of their audiences or patients. Why then do they do it? I examine the logics and effects of their work to identify the forms of inclusion, care, efficacy, and explanation these open up. At the same time, I seek to discern the indirect effects of unequal access to knowledge and resources in the ambivalence, uncertainties, and contradictions that pervade these efforts to inform, diagnose, and advise.<\/jats:p>","DOI":"10.3389\/fphar.2020.561428","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T08:36:32Z","timestamp":1618216592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Filtering Inequality: Screening and Knowledge in Senegal\u2019s Topography of Hepatitis B Care"],"prefix":"10.3389","volume":"11","author":[{"given":"Noemi","family":"Tousignant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,4,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e507","DOI":"10.1016\/S2214-109X(16)30140-1","article-title":"Screen-and-treat for chronic hepatitis B: an overdue issue for sub-Saharan Africa","volume":"4","author":"Allain","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1080\/17474124.2018.1474097","article-title":"The current situation and challenges of screening for and treating hepatitis B in sub-Saharan Africa","volume":"12","author":"B\u00e9guelin","year":"2018","journal-title":"Expert Rev. Gastroenter. Hepatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"637","DOI":"10.4269\/ajtmh.19-0477","article-title":"Limited awareness of hepatitis B but widespread recognition of its Sequelae in rural Senegal: a qualitative study","volume":"102","author":"Boye","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.14428\/emulations.027","article-title":"La longue \u00e9clipse des h\u00e9patites virales en Afrique","volume":"27","author":"Chabrol","year":"2019","journal-title":"Ethnographie \u00e0 l\u2019h\u00f4pital \u00e0 Yaound\u00e9."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e025415","DOI":"10.1136\/bmjopen-2018-025415","article-title":"Screening, diagnosis and care cascade for viral hepatitis B and C in Yaound\u00e9, Cameroon: a qualitative study of patients and health providers coping with uncertainty and unbearable costs","volume":"9","author":"Chabrol","year":"2019","journal-title":"BMJ Open"},{"key":"B6","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1080\/01459740.2018.1518981","article-title":"Viral hepatitis and a hospital infrastructure in ruins in Cameroon","volume":"37","author":"Chabrol","year":"2018","journal-title":"Med. Anthropol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1080\/01459740.2018.1518981","article-title":"Am\u00e9lioration de la qualit\u00e9 sanitaire de l'arachide au S\u00e9n\u00e9gal: un challenge pour une op\u00e9ration de recherche-d\u00e9veloppement participative","volume":"22","author":"Clavel","year":"2013","journal-title":"Cah. Agric."},{"key":"B56","first-page":"431","article-title":"Prevention of liver fibrosis and liver cancer linked to hepatitis B virus in Africa: the Prolifica study","volume":"35","author":"Cohen","year":"2019","journal-title":"Med. Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"S128","DOI":"10.1007\/978-4-431-53977-3_19","article-title":"Hepatitis B virus infection and hepatocellular carcinoma in Senegal: prevalence and prevention","volume":"8","author":"Coursaget","year":"1993","journal-title":"J. Gastroenterol. Hepatol."},{"key":"B9","unstructured":"Antir\u00e9troviraux: P\u00e9nurie d\u2019un medicament essential contre le Vih\/sida\n            DakaractuK.\n          2014"},{"key":"B55","unstructured":"Lutte contre l'h\u00e9patite: la n\u00e9buleuse d'un programme2018"},{"key":"B10","first-page":"115","article-title":"Equity in access to AIDS treatment in Africa: pitfalls among achievements","volume-title":"Unhealthy health Policy. A Critical anthropological examination","author":"Desclaux","year":"2004"},{"key":"B11","volume-title":"Analyses \u00e9conomiques, sociales, comportementales et m\u00e9dicalesL'initiative s\u00e9n\u00e9galaise d'acc\u00e8s aux m\u00e9dicaments antir\u00e9troviraux","author":"Desclaux","year":"2002"},{"key":"B12","unstructured":"Prise en charge des h\u00e9patites: Aristide Le Dantec dot\u00e9 d'un nouvel appareil. Enqu\u00eate plus\n            DiattaG.\n          2016"},{"key":"B13","unstructured":"T\u00e9moignage Ibrahima Gueye, Pr\u00e9sident de l\u2019Association Saafara H\u00e9patite : \u2018\u2019La premi\u00e8re ordonnance qu\u2019on m\u2019a prescrite co\u00fbte 7,300 millions\u2019\u2019\n            DiattaV."},{"key":"B15","unstructured":"Interview : Professeur... communicatoin\n            DiattaV."},{"key":"B16","unstructured":"Journ\u00e9e mondiale de lutte contre les h\u00e9patites: les acteurs plaident la gratuit\u00e9 du d\u00e9pistage\n            DiattaV.\n          2018"},{"key":"B17","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1186\/s12913-019-4416-3","article-title":"12356 AmBASS Study GroupPrevention and care of hepatitis B in the rural region of Fatick in Senegal: a healthcare workers\u2019 perspective using a mixed methods approach","volume":"19","author":"Djaogol","year":"2019","journal-title":"BMC Health Serv. Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"531","DOI":"10.2307\/1161005","article-title":"Mamprusi witchcraft, subversion and changing gender relations","volume":"63","author":"Drucker-Brown","year":"1993","journal-title":"Africa"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2713","DOI":"10.1111\/j.1537-2995.2010.02750.x","article-title":"Sociodemographic and attitudinal factors to blood donation in the urban population of Dakar, Senegal","volume":"50","author":"Duboz","year":"2010","journal-title":"Transfusion"},{"key":"B20","unstructured":"Tribune: H\u00e9patites et Alimentation\n            ErlingerS.\n          2020"},{"key":"B21","doi-asserted-by":"crossref","first-page":"745","DOI":"10.3406\/ahess.1994.279293","article-title":"Le Domaine Priv\u00e9 de la Sant\u00e9 Publique Pouvoir, politique et sida au Congo","volume":"49","author":"Fassin","year":"1994","journal-title":"Ann. Histoire, Sci. Sociales"},{"key":"B57","doi-asserted-by":"crossref","DOI":"10.36019\/9780813549071","volume-title":"Your pocket is what cures you: the politics of health in Senegal","author":"Foley","year":"2009"},{"key":"B23","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1017\/s0001972019000949","article-title":"Imagining viral hepatitis in Burkina Faso","volume":"90","author":"Giles-Vernick","year":"2020","journal-title":"J. Int. Afr. Inst."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.4269\/ajtmh.16-0398","article-title":"Barriers to linkage to care for hepatitis B virus infection: a qualitative analysis in Burkina Faso, West Africa","volume":"95","author":"Giles-Vernick","year":"2016","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/qjmed\/hcv118","article-title":"PROLIFICA: a story of West African clinical and research collaborations to target hepatitis B-related hepatocellular carcinoma in West Africa","volume":"109","author":"Howell","year":"2016","journal-title":"QJM"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1111\/liv.13484","article-title":"Hepatitis B treatment eligibility in West Africa: uncertainties and need for prospective cohort studies","volume":"37","author":"Jaquet","year":"","journal-title":"Liver Int."},{"key":"B27","doi-asserted-by":"publisher","first-page":"389","DOI":"10.4269\/ajtmh.17-0065","article-title":"Prevention and care of hepatitis B in Senegal; awareness and attitudes of medical practitioners","volume":"97","author":"Jaquet","year":"","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"B28","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1111\/j.1548-1387.2010.01109.x","article-title":"\u201cAll I eat is ARVs\u201d: the paradox of AIDS treatment interventions in central Mozambique","volume":"24","author":"Kalofonos","year":"2010","journal-title":"Med. Anthropol. Q."},{"key":"B29","doi-asserted-by":"publisher","first-page":"305","DOI":"10.32388\/8l4r6w","article-title":"Aflatoxins as a cause of hepatocellular carcinoma","volume":"22","author":"Kew","year":"2013","journal-title":"J. Gastrointestin Liver Dis."},{"key":"B30","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.tracli.2017.06.264","article-title":"Connaissances, attitudes et pratiques du personnel soignant du district sanitaire de Richard\u2013Toll (S\u00e9n\u00e9gal) en mati\u00e8re de d\u00e9pistage de l'h\u00e9patite B","volume":"14","author":"Lawson","year":"2017","journal-title":"RAFMI"},{"key":"B31","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1057\/jphp.2012.29","article-title":"In the shadow of HIV\/AIDS: forgotten diseases in sub-Saharan Africa: global health issues and funding agency responsibilities","volume":"33","author":"Lemoine","year":"2012","journal-title":"J. Public Health Policy"},{"key":"B32","volume-title":"Debility and the moral imagination in Botswana","author":"Livingston","year":"2005"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e22291","DOI":"10.1371\/journal.pone.0022291","article-title":"Liver stiffness measurement and biochemical markers in Senegalese chronic hepatitis B patients with normal ALT and high viral load","volume":"6","author":"Mbaye","year":"2011","journal-title":"PLoS One"},{"key":"B34","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/j.jhep.2018.06.002","article-title":"Predicting treatment eligibility for hepatitis B in low income regions: can treatment scores without HBV DNA testing serve the purpose?","volume":"69","author":"McMahon","year":"2018","journal-title":"J. Hepatol."},{"key":"B35","unstructured":"Lutte contre l'h\u00e9patite B: Le traitement subventionn\u00e9 \u00e0 5,000 francs Cfa2017"},{"key":"B37","doi-asserted-by":"crossref","DOI":"10.1215\/9780822393504","volume-title":"The republic of therapy: Triage and sovereignty in West Africa\u2019s time of AIDS","author":"Nguyen","year":"2010"},{"key":"B38","volume-title":"The new public health: Health and self in the age of risk","author":"Petersen","year":"1996"},{"key":"B39","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1111\/j.1537-2995.2012.03756.x","article-title":"Representations and disease experience of hepatitis B by sub-Saharan patients in ivory Coast and France","volume":"26","author":"Pourette","year":"2014","journal-title":"Sante publique (Vandoeuvre-les-Nancy, France)"},{"key":"B40","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1111\/maq.12006","article-title":"HIV and the moral economy of survival in an East African city","volume":"26","author":"Prince","year":"2012","journal-title":"Med. Anthropol. Q."},{"key":"B41","volume-title":"Plan strat\u00e9gique de lutte contre les h\u00e9patites 2019\u20132023. (Document in author\u2019s possession. Posted on hepatites.sn, site not operational at time of publication","year":"2018"},{"key":"B42","volume-title":"AIDS activism and globalisation from below: occupying new spaces of citizenship in post-apartheid South Africa","author":"Robins","year":"2004"},{"key":"B43","unstructured":"November) La conf\u00e9rence de Dakar sur les h\u00e9patites, une conf\u00e9rence qui fera date\n            Sall DialloA.\n          2012"},{"key":"B44","unstructured":"Sall DialloA.\n          2018"},{"key":"B45","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/s1473-3099(17)30339-0","article-title":"Improving communication about viral hepatitis in Africa","volume":"17","author":"Shimakawa","year":"2017","journal-title":"Lancet Infect Dis."},{"key":"B46","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/s1473-3099(17)30339-0","article-title":"Les marqueurs non invasifs dans l'\u00e9valuation de la fibrose h\u00e9patique chez des s\u00e9n\u00e9galais porteurs chroniques du virus de l'h\u00e9patite B: \u00e0 propos de 404 cas","volume":"4","author":"Tour\u00e9","year":"2017","journal-title":"RAFMI"},{"key":"B47","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.revmed.2015.10.184","article-title":"A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan","volume":"12","author":"ul Haq","year":"2012","journal-title":"BMC Public Health"},{"key":"B48","doi-asserted-by":"publisher","first-page":"329","DOI":"10.15557\/jou.2019.0014","article-title":"Molecular epidemiology of hepatitis B virus in Dakar, Senegal","volume":"78","author":"Vray","year":"2006","journal-title":"J. Med. Virol."},{"key":"B49","volume-title":"Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection","author":"WHO","year":"2015"},{"key":"B50","volume-title":"Guidelines on hepatitis B and C testing","author":"WHO","year":"2017"},{"key":"B51","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1515\/9780822387916-010","article-title":"Treating AIDS: dilemmas of unequal access in Uganda","volume":"1","author":"Whyte","year":"2004","journal-title":"Sahara-j: J. Soc. Aspects Hiv\/aids"},{"key":"B52","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1086\/698359","article-title":"Technologies of inquiry: HIV tests and divination","volume":"8","author":"Whyte","year":"2018","journal-title":"HAU: J. Ethnogr. Theor."},{"key":"B53","doi-asserted-by":"crossref","DOI":"10.1596\/0-1952-0890-0","volume-title":"World Development Report 1993: Investing in Health","author":"World Bank","year":"1993"},{"key":"B54","volume-title":"L'h\u00e9patite une maladie bien pr\u00e9sent au Senegal. Quelles solution selon Ibrahima Gueye","author":"Yesdakar","year":"2019"}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2020.561428\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T08:37:48Z","timestamp":1618216668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2020.561428\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,12]]},"references-count":54,"alternative-id":["10.3389\/fphar.2020.561428"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2020.561428","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,12]]},"article-number":"561428"}}