BackgroundHealth workers in sub-Saharan Africa can now diagnose and treat malaria in the field, using rapid diagnostic tests and artemisinin-based combination therapy in areas without microscopy and widespread resistance to previously effective drugs.ObjectiveThis study evaluates communities’ perceptions of a new community case management of malaria programme in the district of Saraya, south-eastern Senegal, the effectiveness of lay health worker trainings, and the availability of rapid diagnostic tests and artemisinin-based combination therapy in the field.MethodsThe study employed qualitative and quantitative methods including focus groups with villagers, and pre- and post-training questionnaires with lay health workers.ResultsCommunities approved of the community case management programme, but expressed concern about other general barriers to care, particularly transportation challenges. Most lay health workers acquired important skills, but a sizeable minority did not understand the rapid diagnostic test algorithm and were not able to correctly prescribe arteminisin-based combination therapy soon after the training. Further, few women lay health workers participated in the programme. Finally, the study identified stock-outs of rapid tests and anti-malaria medication products in over half of the programme sites two months after the start of the programme, thought due to a regional shortage.ConclusionThis study identified barriers to implementation of the community case management of malaria programme in Saraya that include lay health worker training, low numbers of women participants, and generalized stock-outs. These barriers warrant investigation into possible solutions of relevance to community case management generally.

BackgroundDespite recent advances in malaria diagnosis and treatment, many isolated communities in rural settings continue to lack access to these life-saving tools. Community-case management of malaria (CCMm), consisting of lay health workers (LHWs) using malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) in their villages, can address this disparity.MethodsThis study examined routine reporting data from a CCMm programme between 2008 and 2011 in Saraya, a rural district in Senegal, and assessed its impact on timely access to rapid diagnostic tests and ACT.ResultsThere was a seven-fold increase in the number of LHWs providing care and in the number of patients seen. LHW engagement in the CCM programme varied seasonally, 24,3% of all patients prescribed an ACT had a negative RDT or were never administered an RDT, and less than half of patients with absolute indications for referral (severe symptoms, age under two months and pregnancy) were referred. There were few stock-outs.DiscussionThis CCMm programme successfully increased the number of patients with access to RDT and ACT, but further investigation is required to identify the cause for over-prescription, and low rates of referrals for patients with absolute indications. In contrast, previous widespread stock-outs in Saraya’s CCMm programme have now been resolved.ConclusionThis study demonstrates the potential for CCMm programmes to substantially increase access to life-saving malarial diagnostics and treatment, but also highlights important challenges in ensuring quality.

Hepatitis B virus (HBV) is highly endemic in West Africa and immigration from this region to the United States has greatly increased over the past quarter century. Using the Andersen Model as a conceptual framework, this study qualitatively examines francophone West African immigrants' perceptions of factors affecting access to HBV screening and linkage-to-care in New York City. Four focus groups were conducted with 39 purposefully selected participants. The focus groups were conducted in French, audio-recorded, translated into English, transcribed, analyzed, and coded for major themes. Participants identified increasing knowledge of HBV and opportunities to access care in a culturally-sensitive manner that decreases fatalism and avoids generating stigma as priorities. They also emphasized the importance of engaging religious establishments and social networks and employing the Internet to disseminate HBV-relevant information. Cost and health insurance are identified as future challenges that will need to be addressed in a health care environment in which undocumented immigrants are ineligible for health insurance. The qualitative analysis in this study highlights the recursive and interdependent nature of the Andersen Model, and a modification of the model is proposed that is intended to inform examinations of other minority communities' access to health care.

The number of African-born residents living in the United States (US) increased by more than 750 % between 1980 and 2009. HIV diagnosis rates in this population are six times higher than estimated incidence in the general US population. African-immigrants with HIV are also diagnosed at later stages of infection than US-born residents, but they paradoxically have lower mortality after diagnosis. There are higher rates of HIV among women, higher rates of heterosexual transmission, and lower rates of injection-drug-use-associated transmission among African-born residents in the US relative to the general US population. Despite this distinct epidemiologic profile, surveillance reports often group African-born residents with US-born Blacks. The high rates of HIV among African-born residents in the US combined with increasing immigration and incomplete surveillance data highlight the need for more accurate epidemiologic data along with appropriate HIV service programs.