Screening, diagnosis and care cascade for viral hepatitis B and C in Yaoundé, Cameroon: a qualitative study of patients and health providers coping with uncertainty and unbearable costs. Issue 3 (20th March 2019)

• Record Type: Journal Article
• Authors: Chabrol, Fanny; Noah Noah, Dominique; Tchoumi, Eric Pascal; Vidal, Laurent; Kuaban, Christopher; Carrieri, Maria Patrizia; Boyer, Sylvie
• Other Names: author non-byline.; Kuaban C author non-byline.; Vidal L author non-byline.; Maradan G author non-byline.; Ambani A author non-byline.; Ndalle O author non-byline.; Momo P author non-byline.; Tong C author non-byline.; Boyer S author non-byline.; Boyer V author non-byline.; March L author non-byline.; Mora M author non-byline.; Sagaon-Teyssier L author non-byline.; Sèze M De author non-byline.; Spire B author non-byline.; Monti M Suzan­ author non-byline.; Laurent C author non-byline.; Liégeois F author non-byline.; Delaporte E author non-byline.; Boyer V author non-byline.; Duvernay S Eymard­ author non-byline.; Chabrol F author non-byline.; Kouakam E author non-byline.; Ossanga O author non-byline.; Owona H Essama author non-byline.; Biloa C author non-byline.; Mengue M T author non-byline.; Ngolé E Mpoudi author non-byline.; Fouda P J author non-byline.; Kouanfack C author non-byline.; Abessolo H author non-byline.; Noumssi N author non-byline.; Defo M author non-byline.; Meli H author non-byline.; Nanga Z author non-byline.; Perfura Y author non-byline.; Tonye M Ngo author non-byline.; Kouambo O author non-byline.; Olinga U author non-byline.; Soh E author non-byline.; Ejangue C author non-byline.; Nlend E Njom author non-byline.; Ndongo A Simo author non-byline.; Mbozo'o E Abeng author non-byline.; Ngole M Mpoudi author non-byline.; Manga N author non-byline.; Danwe C author non-byline.; Ayangma L author non-byline.; Taman B author non-byline.; Njitoyap ndam E C author non-byline.; Molu B Fangam author non-byline.; Meli J author non-byline.; Hadja H author non-byline.; Lindou J author non-byline.; Bob Oyono J M author non-byline.; Beke S author non-byline.; Eloundou D author non-byline.; Touko G author non-byline.; Ze J J author non-byline.; Fokoua M author non-byline.; Ngum L author non-byline.; Ewolo C author non-byline.; Bondze C author non-byline.; Ngan Bilong J D author non-byline.; Maninzou D S author non-byline.; Toche A Nono author non-byline.; Akoa M Tsoungi author non-byline.; Ateba P author non-byline.; Abia S author non-byline.; Guterrez A author non-byline.; Garcia R author non-byline.; Thumerel P author non-byline.; Priso E Belley author non-byline.; Mapoure Y author non-byline.; Malongue A author non-byline.; Meledie Ndjong A P author non-byline.; Mbatchou B author non-byline.; Hachu J author non-byline.; Ngwane S author non-byline.; Dissongo J author non-byline.; Mbangue M author non-byline.; Penda Ida author non-byline.; Mossi H author non-byline.; Tchatchoua G author non-byline.; Ngongang Yoyo author non-byline.; Nouboue C author non-byline.; Wandji I author non-byline.; Ndalle L author non-byline.; Djene J author non-byline.; Gomez M J author non-byline.; Mafuta A author non-byline.; Mgantcha M author non-byline.; Moby E H author non-byline.; Kuitcheu M C author non-byline.; Mawe A L author non-byline.; Engonwei Ngam author non-byline.; Bitang L J author non-byline.; Ndam M author non-byline.; Pallawo R B author non-byline.; Adamou Issiakou author non-byline.; Temgoua G author non-byline.; Essaga C Ndjie author non-byline.; Tchimou C author non-byline.; Yeffou A author non-byline.; Ngo I author non-byline.; Fokam H author non-byline.; Nyemb H author non-byline.; Njock L R author non-byline.; Omgnesseck S author non-byline.; Kamto E author non-byline.; Takou B author non-byline.; Buffeteau L J­g author non-byline.; Ndoumbe F author non-byline.; Noah J D author non-byline.; Seyep I author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 3(2019)
• Publication Date: 2019-03-20
• Subjects: viral hepatitis B -- viral hepatitis C -- Cameroon -- qualitative study; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-025415
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To document patients' and healthcare professionals' (HCP) experiences with hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnosis and care, as well as consequences of these infections on patients' life trajectories in Cameroon, an endemic country in sub-Saharan Africa. Design: Qualitative sociological study combining in-depth interviews and observations of medical consultations. Interviews and observations transcripts were thematically analysed according to the following themes: circumstances and perceptions surrounding hepatitis screening, counselling and disclosure, information provided by HCP on hepatitis prevention and treatment, experience of access to care and treatment, social/economic trajectories after diagnosis. Setting: HIV and gastroenterology/medical services in two reference public hospitals in Yaoundé (Cameroon). Participants: 12 patients affected by HBV and/or HCV (co-infected or not with HIV), 14 HCP, 14 state and international stakeholders. Findings: Many patients are screened for HBV and HCV at a time of great emotional and economic vulnerability. The information and counselling delivered after diagnosis is limited and patients report feeling alone, distressed and unprepared to cope with their infection. After screening positive, patients struggle with out-of-pocket expenditures related to the large number of tests prescribed by physicians to assess disease stage and to decide whether treatment is needed. These costs are so exorbitant that many decide against clinical and biological follow-up. For those who do pay, the consequences on their social and economic life trajectories are catastrophic. Conclusion: Large out-of-pocket expenditures related to biological follow-up and treatment pose a real challenge to receiving appropriate care. Free or reasonably priced access to hepatitis B and C treatments can only be effective and efficient at reducing the hepatitis disease burden if the screening algorithm and the whole pretherapeutic assessment package are simplified, standardised and subsidised by comprehensive national policies orientated towards universal healthcare.