{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:10:00Z","timestamp":1790313000954,"version":"4.1.0"},"reference-count":28,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,12,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n<jats:p>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.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0398","type":"journal-article","created":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T02:29:06Z","timestamp":1477362546000},"page":"1368-1375","source":"Crossref","is-referenced-by-count":43,"title":["Barriers to Linkage to Care for Hepatitis B Virus Infection: A Qualitative Analysis in Burkina Faso, West Africa"],"prefix":"10.4269","volume":"95","author":[{"given":"Tamara","family":"Giles-Vernick","sequence":"first","affiliation":[{"name":"Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Hejoaka","sequence":"additional","affiliation":[{"name":"Unit\u00e9 Mixte Internationale (UMI) 233\/U1175 TransVIH, Institut de Recherche pour le D\u00e9veloppement\/Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale (INSERM), Montpellier, France."},{"name":"Centre de Recherche sur les M\u00e9diations, Universit\u00e9 de Lorraine, Metz, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armande","family":"Sanou","sequence":"additional","affiliation":[{"name":"Groupe de Recherche Action en Sant\u00e9, Ouagadougou, Burkina Faso."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Shimakawa","sequence":"additional","affiliation":[{"name":"Emerging Diseases Epidemiology Unit, Pasteur Institute, Paris, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issiaka","family":"Bamba","sequence":"additional","affiliation":[{"name":"Sciences de l'Homme Appliqu\u00e9es au D\u00e9veloppement et \u00e0 l'Evaluation des Interventions (SHADEI), Centre Muraz, Bobo-Dioulasso, Burkina Faso."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdoulaye","family":"Traor\u00e9","sequence":"additional","affiliation":[{"name":"Groupe de Recherche Action en Sant\u00e9, Ouagadougou, Burkina Faso."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection","author":"WHO","year":"2015"},{"key":"ref2","series-title":"Gut","article-title":"Natural history of chronic HBV infection in west Africa: a longitudinal population-based study from The Gambia","author":"Shimakawa","year":"2015"},{"key":"ref3","series-title":"N Engl J Med","first-page":"1118","article-title":"Hepatocellular cancer","volume":"365","author":"El-Serag","year":"2011"},{"key":"ref4","series-title":"J Hepatol","first-page":"469","article-title":"Reducing the neglected burden of viral hepatitis in Africa: strategies for a global approach","volume":"62","author":"Lemoine","year":"2015"},{"key":"ref5","series-title":"Trans R Soc Trop Med Hyg","first-page":"421","article-title":"Chronic hepatitis B infection in sub-Saharan Africa: a grave challenge and a great hope","volume":"109","author":"Stockdale","year":"2015"},{"key":"ref6","series-title":"Anthropol Med","first-page":"163","article-title":"Infusions of health: the popularity of vaccinations among Bissa in Burkina Faso","volume":"8","author":"Samuelsen","year":"2001"},{"key":"ref7","series-title":"Soc Sci Med","first-page":"2157","article-title":"New therapeutic landscapes in Africa: parental categories and practices in seeking infant health in the Republic of Guinea","volume":"66","author":"Leach","year":"2008"},{"key":"ref8","series-title":"Soc Sci Med","first-page":"405","article-title":"Camel milk, amoxicillin, and a prayer: medical pluralism and medical humanitarian aid in the Somali Region of Ethiopia","volume":"120","author":"Carruth","year":"2014"},{"key":"ref9","series-title":"Sant\u00e9 Publique","first-page":"869","article-title":"Repr\u00e9sentations et v\u00e9cu de l'h\u00e9patite B de patients subsahariens en C\u00f4te d'Ivoire et en France: representations and disease experience of hepatitis B by Sub-Saharan patients in Ivory Coast and France","volume":"26","author":"Pourette","year":"2014"},{"key":"ref10","series-title":"Health Place","first-page":"89","article-title":"Hepatitis B in Ghana's upper west region: a hidden epidemic in need of national policy attention","volume":"23","author":"Mkandawire","year":"2013"},{"key":"ref11","series-title":"J Community Health","first-page":"175","article-title":"Adapting the Andersen model to a francophone west African immigrant population: hepatitis B screening and linkage to care in New York City","volume":"40","author":"Blanas","year":"2015"},{"key":"ref12","series-title":"Open Forum Infect Dis","first-page":"ofv122","article-title":"A survey study of pregnant women and healthcare practitioners assessing the knowledge of attitudes and practices of hepatitis B management at a teaching hospital in Kumasi, Ghana, west Africa","volume":"2","author":"Cheng","year":"2015"},{"key":"ref13","series-title":"Sant\u00e9 Publique","first-page":"561","article-title":"Prise en charge du VIH et de l'h\u00e9patite B chronique chez les migrants subsahariens en France: le r\u00f4le-cl\u00e9 de la relation m\u00e9decin-patient","volume":"25","author":"Pourette","year":"2013"},{"key":"ref14","series-title":"BMC Infect Dis","first-page":"1","article-title":"Hepatitis B vaccine knowledge and vaccination status among health care workers of Bahir Dar City Administration, northwest Ethiopia: a cross sectional study","volume":"15","author":"Abeje","year":"2015"},{"key":"ref15","series-title":"Lancet","first-page":"1546","article-title":"Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013","volume":"386","author":"Schweitzer","year":"2015"},{"key":"ref16","series-title":"PLoS Negl Trop Dis","first-page":"e2859","article-title":"The need for more research and public health interventions on dengue fever in Burkina Faso","volume":"8","author":"Ridde","year":"2014"},{"key":"ref17","series-title":"Soc Sci Med","first-page":"1368","article-title":"\u201cThe problem of the worst-off is dealt with after all other issues\u201d: the equity and health policy implementation gap in Burkina Faso","volume":"66","author":"Ridde","year":"2008"},{"key":"ref18","series-title":"Population Des Principales Villes","author":"INSD","year":"2013"},{"key":"ref19","series-title":"Annuaire Statistique. Ouagadougou: Minist\u00e8re de l'\u00c9conomie et des Finances","author":"INSD","year":"2013"},{"key":"ref20","series-title":"Am J Trop Med Hyg","first-page":"454","article-title":"Comparison of elastography, serum marker scores, and histology for the assessment of liver fibrosis in hepatitis B virus (HBV)-infected patients in Burkina Faso","volume":"82","author":"Bonnard","year":"2010"},{"key":"ref21","series-title":"Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis","author":"Charmaz","year":"2006"},{"key":"ref22","series-title":"Health Place","first-page":"836","article-title":"Malaria, environmental change, and a historical epidemiology of childhood \u2018cold fevers\u2019: popular interpretations from southwestern Burkina Faso","volume":"17","author":"Giles-Vernick","year":"2011"},{"key":"ref23","series-title":"Anthropol Med","first-page":"307","article-title":"Translating malaria as sumaya: justified convention or inappropriateness?","volume":"16","author":"Dugas","year":"2009"},{"key":"ref24","series-title":"World Development Report","author":"World Bank","year":"2015"},{"key":"ref25","series-title":"J Health Serv Res Policy","first-page":"186","article-title":"What does \u2018access to health care' mean?","volume":"7","author":"Gulliford","year":"2002"},{"key":"ref26","series-title":"Am J Trop Med Hyg","first-page":"1100","article-title":"Knowledge of hepatitis B transmission risks among health workers in Tanzania","volume":"94","author":"Debes","year":"2016"},{"key":"ref27","series-title":"J R Anthropol Inst","first-page":"706","article-title":"Graves, ruins, and belonging: towards an anthropology of proximity","volume":"17","author":"Fontein","year":"2011"},{"key":"ref28","series-title":"Med Anthropol Q","first-page":"280","article-title":"Material proximities and hotspots: toward an anthropology of viral hemorrhagic fevers","volume":"28","author":"Brown","year":"2014"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/6\/article-p1368.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/6\/article-p1368.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/95\/6\/article-p1368.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:51:18Z","timestamp":1723067478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/95\/6\/article-p1368.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,7]]},"references-count":28,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0398","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,7]]}}}