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

Abstract

ObjectivesTo 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.DesignQualitative 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.SettingHIV and gastroenterology/medical services in two reference public hospitals in Yaoundé (Cameroon).Participants12 patients affected by HBV and/or HCV (co-infected or not with HIV), 14 HCP, 14 state and international stakeholders.FindingsMany 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.ConclusionLarge 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.

Achieving a high cure rate with direct‐acting antivirals for chronic Hepatitis C virus infection in Cameroon: a multi‐clinic demonstration project

“…The general health of PLHCV in this cohort was poor, likely due to late diagnosis after the onset of liver disease symptoms and in the context of high age and presence of other co-morbidities [13]. Kidney failure and chronic diseases such as diabetes and hypertension are prevalent among older PLHCV with a higher risk of mortality [37,38].…”

“…Study participants were recruited among patients already identified through gastroenterology consultation. These patients had usually been diagnosed after presenting with liver-related symptoms or following blood donation [13].…”

“…Additionally, the lack of national screening and treatment guidelines, central organisation of Hepatitis C care, insufficient technical and human capacity for HCV testing, alongside high costs associated with diagnosis and treatment (generally paid out-of-pocket), substantially limit access to HCV diagnosis and care. Most PLHCV in Cameroon are unaware of their status, with a negative impact on transmission and disease progression [13][14][15].…”

The Lived Experience of Chronic Hepatitis B: A Broader View of Its Impacts and Why We Need a Cure

“…Tertiary impacts: the harms associated with an affected person's response to societal stigma and discrimination. The initial reaction upon a diagnosis of HBV infection is generally one of stress and anxiety about one's own health and future [29][30][31][32][33][34], which continues throughout a chronic infection as an intermittent worry about disease progression and premature death at a young age. Increased health-related fears have been linked to greater knowledge about HBV, particularly of HBV-related complications (e.g., the possibility of liver cancer) [35][36][37][38].…”

<p>Developing an Indicator System for a Healthy City: Taking an Urban Area as a Pilot</p>

“…The thematical analysis was used to analyze the detailed interview/discussion notes line-by-line based on grounded theory. [26][27][28] The results were presented in aggregate across respondents to protect the identities of the individuals. The final list of recommended indicators was formed through a review of government documents, focus group discussions, and in-depth interviews ( Figure 1).…”