Volume 100, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Brun R, Blum J, Chappuis F, Burri C, , 2010. Human African trypanosomiasis. Lancet 375: 148159. [Google Scholar]
  2. Franco JR, Simarro PP, Diarra A, Jannin JG, , 2014. Epidemiology of human African trypanosomiasis. Clin Epidemiol 6: 257275. [Google Scholar]
  3. WHO, 2013. Control and surveillance of human African trypanosomiasis. World Health Organ Tech Rep Ser 2013: 1237. [Google Scholar]
  4. Buscher P, Cecchi G, Jamonneau V, Priotto G, , 2017. Human African trypanosomiasis. Lancet 390: 23972409. [Google Scholar]
  5. Blum J, Schmid C, Burri C, , 2006. Clinical aspects of 2541 patients with second stage human African trypanosomiasis. Acta Trop 97: 5564. [Google Scholar]
  6. Buguet A, Bourdon L, Bisser S, Chapotot F, Radomski M, Dumas M, , 2001. Sleeping sickness: major disorders of circadian rhythm [article in French]. Med Trop (Mars) 61: 328339. [Google Scholar]
  7. Kennedy PG, , 2006. Human African trypanosomiasis-neurological aspects. J Neurol 253: 411416. [Google Scholar]
  8. Simarro PP, Diarra A, Ruiz Postigo JA, Franco JR, Jannin JG, , 2011. The human African trypanosomiasis control and surveillance programme of the World Health Organization 2000–2009: the way forward. PLoS Negl Trop Dis 5: e1007. [Google Scholar]
  9. Eperon G, Balasegaram M, Potet J, Mowbray C, Valverde O, Chappuis F, , 2014. Treatment options for second-stage gambiense human African trypanosomiasis. Expert Rev Anti Infect Ther 12: 14071417. [Google Scholar]
  10. Mitashi P, Hasker E, Mbo F, Van Geertruyden J, Kaswa M, Lumbala C, Boelaert M, Lutumba P, , 2015. Integration of diagnosis and treatment of sleeping sickness in primary healthcare facilities in the Democratic Republic of the Congo. Trop Med Int Health 20: 98105. [Google Scholar]
  11. Simarro PP, Sima FO, Mir M, Mateo MJ, Roche J, , 1991. Control of human African trypanosomiasis in Luba in equatorial Guinea: evaluation of three methods. Bull World Health Organ 69: 451457. [Google Scholar]
  12. WHO, 1998. Control and surveillance of African trypanosomiasis. World Health Organ Tech Rep Ser 881: 1114. [Google Scholar]
  13. Holmes P, , 2014. First WHO meeting of stakeholders on elimination of gambiense human African trypanosomiasis. PLoS Negl Trop Dis 8: e3244. [Google Scholar]
  14. Simarro PP, Cecchi G, Franco JR, Paone M, Diarra A, Priotto G, Mattioli RC, Jannin JG, , 2015. Monitoring the progress towards the elimination of gambiense human African trypanosomiasis. PLoS Negl Trop Dis 9: e0003785. [Google Scholar]
  15. Pepin J, Guern C, Milord F, Bokelo M, , 1989. Integration of African human trypanosomiasis control in a network of multipurpose health centers. Bull World Health Organ 67: 301308. [Google Scholar]
  16. Laveissiere C, Meda AH, Doua F, Sane B, , 1998. Detecting sleeping sickness: comparative efficacy of mobile teams and community health workers. Bull World Health Organ 76: 559564. [Google Scholar]
  17. Franco JR, Simarro PP, Diarra A, Ruiz-Postigo JA, Jannin JG, , 2014. The journey towards elimination of gambiense human African trypanosomiasis: not far, nor easy. Parasitology 141: 748760. [Google Scholar]
  18. Lumbala C, 2015. Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk. Int J Health Geogr 14: 114. [Google Scholar]
  19. Van Nieuwenhove S, Betu-Ku-Mesu V, Diabakana P, Declercq J, Bilenge C, , 2001. Sleeping sickness resurgence in the DRC: the past decade. Trop Med Int Health 6: 335341. [Google Scholar]
  20. Ochieng N, Wilson K, Derrick C, Mukherjee N, , 2018. The use of focus group discussion methodology: insights from two decades of application in conservation. Methods Ecol Evol 9: 2032. [Google Scholar]
  21. Kohn L, Christiaens W, , 2014. Les méthodes de recherches qualitatives dans la recherche en soins de santé: apports et croyances. Reflets et Perspectives de la vie Économique LIII: 6782. [Google Scholar]
  22. Mukamurera J, Lacourse F, Couturier Y, , 2006. Des avancées en analyse qualitative: pour une transparence et une systématisation des pratiques. Recherches qualitatives 26: 110138. [Google Scholar]
  23. Tong A, Sainsbury P, Craig J, , 2007. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19: 349357. [Google Scholar]
  24. Arun NN, Mohan KI, Parthasarathy R, Karur BV, , 1994. The perception and experience of health personnel about the integration of mental health in general health services. Indian J Psychiat 36: 1821. [Google Scholar]
  25. Criel B, De Brouwere V, Van Lerberghe W, Béthune X, , 1997. Conditions, limites et potentiel de l’intégration. , eds. Intégration et Recherche. Antwerpen, Belgium: Studies in Health Services Organisation & Policy, 95123. [Google Scholar]
  26. Workneh MH, Bjune GA, Yimer SA, , 2016. Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in south-eastern Amhara Region, Ethiopia: a qualitative study. BMC Health Serv Res 16: 135. [Google Scholar]
  27. Roos B, Van Brakel W, , 1994. Integration of vertical projects into the basic health services: an example from the leprosy control project. Int Nepalese Med Assoc 32: 273286. [Google Scholar]
  28. Méda ZC, Huang CC, Sombié I, Konaté L, Somda PK, Djibougou AD, Sanou M, , 2014. Tuberculosis in developing countries: conditions for successful use of a decentralized approach in a rural health district. Pan Afr Med J 17: 198. [Google Scholar]
  29. Criel B, Kegels G, Van der Stuyft P, , 2004. A framework for analysing the relationship between disease control programmes and basic health care. Trop Med Int Health 9: A1A4. [Google Scholar]
  30. Robays J, Lefèvre P, Lutumba P, Lubanza S, Kande V, Van der Stuyft P, Boelaert M, , 2007. Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo. Trop Med Int Health 12: 290298. [Google Scholar]
  31. Wamboga C, Matovu E, Bessell P, Picado A, Biéler S, Ndung’u J, Arez A, , 2017. Enhanced passive screening and diagnosis for gambiense human African trypanosomiasis in north-western Uganda moving towards elimination. PLoS One 12: e0186429. [Google Scholar]

Data & Media loading...

  • Received : 04 May 2018
  • Accepted : 08 Dec 2018
  • Published online : 04 Feb 2019

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error