Barriers to Linkage to Care for Hepatitis B Virus Infection: A Qualitative Analysis in Burkina Faso, West Africa

Abstract

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.

Environmental factors affecting self‐management of chronic hepatitis B from the patients’ perspective

“…The study revealed that relatives’ treatment experience can help patients become aware of their own diseases. This result was similar to that of previous studies, indicating that patients received conventional treatment on the basis of family members’ personal healthcare experiences (Fang & Stewart, ; Giles‐Vernick et al, ). Some studies have indicated that patients refused screenings and follow‐up because of the fear of unfavourable results and social stigma (Ezbarami et al, ; Yang, ), but the current study did not produce similar results.…”

“…The study revealed that relatives' treatment experience can help patients become aware of their own diseases. This result was similar to that of previous studies, indicating that patients received conventional treatment on the basis of family members' personal healthcare experiences (Fang & Stewart, 2018;Giles-Vernick et al, 2016).…”

“…Traditional health beliefs in the culture affect self‐management behaviours of patients with hepatitis B virus (Fang & Stewart, ; Giles‐Vernick et al, ); however, relevant studies have rarely explained this phenomenon. The present study revealed that when patients perceived that the availability of conventional treatment was only adequate for controlling symptoms, they would seek alternative treatments due to cultural beliefs.…”

“…Studies of patients with liver disease worldwide have suggested that patients’ explanations of symptoms (such as fatigue and tiredness) may be influenced by folk health beliefs, which affect the health behaviours and management of the disease, including adopting new lifestyles or alternative/traditional treatments (Brener et al, ; Burnham et al, ; Owiti, Greenhalgh, Sweeney, Foster, & Bhui, ). Traditional treatments are often related to cultural beliefs, including spiritual healing (Fang & Stewart, ), remedial or healing herbs (Fang & Stewart, ; Giles‐Vernick et al, ). In the patients' experience, these treatments are often used as alternative treatments instead of usual medical treatment (Fang & Stewart, ; Lee et al, ; Owiti et al, ).…”

Help-Seeking Experiences of Hepatitis B Patients in Transnational Medical Care: The Solution to Health Inequality Is Social Mobility

“…In the southeast region of Asia, about 100 million people have chronic HBV infection. The prevalence of chronic viral hepatitis in this region is 30-times more than that of human immunodeficiency virus (HIV) [25].…”