{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:28:03Z","timestamp":1790659683947,"version":"4.1.0"},"reference-count":31,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,3]]},"abstract":"<jats:p>Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of the Democratic Republic of the Congo and held 32 interviews with health-care providers, managers, policy makers, and public health experts. The topic guide focused on enabling and blocking factors related to the integrated diagnosis and treatment approach. The data were analyzed with NVivo (QSR International, Melbourne, Australia) using a thematic analysis process. The results showed that the community mostly welcomed integrated care for diagnosis and treatment of sleeping sickness, as they value the proximity of first-line health services, but feared possible financial barriers. Health-care professionals thought integration contributed to the elimination goal but identified several implementation challenges, such as the lack of skills, equipment, motivation and financial resources in these basic health services. Patients often use multiple therapeutic itineraries that do not necessarily lead them to health centers where screening is available. Financial barriers are important, as health care is not free in first-line health centers, in contrast to the population screening campaigns. Communities and providers signal several challenges regarding the integration process. To succeed, the required training of health professionals, as well as staff deployment and remuneration policy and the financial barriers in the primary care system need to be addressed, to ensure coverage for those most in need.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0382","type":"journal-article","created":{"date-parts":[[2019,2,5]],"date-time":"2019-02-05T07:00:38Z","timestamp":1549350038000},"page":"899-906","source":"Crossref","is-referenced-by-count":11,"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"],"prefix":"10.4269","volume":"100","author":[{"given":"Philippe","family":"Mulenga","sequence":"first","affiliation":[{"name":"Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, DRC;"},{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;"},{"name":"School of Public Health, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen","family":"Boelaert","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Lutumba","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, DRC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catiane","family":"Vander Kelen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Coppieters","sequence":"additional","affiliation":[{"name":"School of Public Health, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faustin","family":"Chenge","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, DRC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crispin","family":"Lumbala","sequence":"additional","affiliation":[{"name":"National Program for the Control of Human African Trypanosomiasis, Kinshasa, DRC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Luboya","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and School of Public Health, University of Lubumbashi, Lubumbashi, DRC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Mpanya","sequence":"additional","affiliation":[{"name":"National Program for the Control of Human African Trypanosomiasis, Kinshasa, DRC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"148","article-title":"Human African trypanosomiasis","volume":"375","author":"Brun","year":"2010"},{"key":"b2","series-title":"Clin Epidemiol","first-page":"257","article-title":"Epidemiology of human African trypanosomiasis","volume":"6","author":"Franco","year":"2014"},{"key":"b3","series-title":"World Health Organ Tech Rep Ser","first-page":"1","article-title":"Control and surveillance of human African trypanosomiasis","volume":"2013","author":"WHO","year":"2013"},{"key":"b4","series-title":"Lancet","first-page":"2397","article-title":"Human African trypanosomiasis","volume":"390","author":"Buscher","year":"2017"},{"key":"b5","series-title":"Acta Trop","first-page":"55","article-title":"Clinical aspects of 2541 patients with second stage human African trypanosomiasis","volume":"97","author":"Blum","year":"2006"},{"key":"b6","series-title":"Med 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trypanosomiasis","volume":"9","author":"Simarro","year":"2015"},{"key":"b15","series-title":"Bull World Health Organ","first-page":"301","article-title":"Integration of African human trypanosomiasis control in a network of multipurpose health centers","volume":"67","author":"Pepin","year":"1989"},{"key":"b16","series-title":"Bull World Health Organ","first-page":"559","article-title":"Detecting sleeping sickness: comparative efficacy of mobile teams and community health workers","volume":"76","author":"Laveissiere","year":"1998"},{"key":"b17","series-title":"Parasitology","first-page":"748","article-title":"The journey towards elimination of gambiense human African trypanosomiasis: not far, nor easy","volume":"141","author":"Franco","year":"2014"},{"key":"b18","series-title":"Int J Health Geogr","first-page":"1","article-title":"Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk","volume":"14","author":"Lumbala","year":"2015"},{"key":"b19","series-title":"Trop Med Int Health","first-page":"335","article-title":"Sleeping sickness resurgence in the DRC: the past decade","volume":"6","author":"Van Nieuwenhove","year":"2001"},{"key":"b20","series-title":"Methods Ecol Evol","first-page":"20","article-title":"The use of focus group discussion methodology: insights from two decades of application in conservation","volume":"9","author":"Ochieng","year":"2018"},{"key":"b21","series-title":"Reflets et Perspectives de la vie \u00c9conomique LIII","first-page":"67","article-title":"Les m\u00e9thodes de recherches qualitatives dans la recherche en soins de sant\u00e9: apports et croyances","author":"Kohn","year":"2014"},{"key":"b22","series-title":"Recherches qualitatives","first-page":"110","article-title":"Des avanc\u00e9es en analyse qualitative: pour une transparence et une syst\u00e9matisation des 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