Table 2.
Overview of documents published or written après 1998 (n = 20)
| Reference | Study design | Arguments for integrated HAT screening | Favorable factors (F)/Obstacles (O) | Lessons learned |
|---|---|---|---|---|
| Van Nieuwenhove et al.7 | Analysis of routine HAT data reported to PNLTHA in DRC 1989–98 | – | – | A functional health service can miss a nearby HAT resurgence if no active screening/surveillance is conducted |
| Louis9 | Debate | – | – | A combination of active and passive screening, and vector control is required to avoid resurgence |
| Simarro et al.10 | Analysis of global reported HAT data 1997–2006 | Sustainability | O: The existing tools inadequate for primary health center. Lack of a sensitive and specific diagnostic test and of a drug that is cheap, safe, and easy to administer. | “Sustainability can only be achieved through an integration of activities in a strengthened health system able to face such responsibilities. The current approach should include specialised teams and healthcare systems, rather than falling back on the former debate between the value of specialized teams or primary healthcare. In other words, specialized teams and primary healthcare need to work together synergistically” |
| Rapport de Formulation39 | Policy paper | Cost coverage | – | “Une stratégie d’intégration est le seul moyen de répondre au fait que les unités mobiles n’arrivent assurer une couverture totale” |
| Hasker et al.45 | Random sample survey on health-seeking behavior | 1. Declining uptake of active screening for HAT and better acceptability of integrated screening | O1: Very long patient and health system delays (median 4 and 2 months, respectively) in integrated screening before reaching a HAT diagnosis | 1. Financial barriers explain long patient delay |
| O2: High out of pocket expenditure (median 44 USD) before HAT diagnosis is reached | 2. Patient delay was less at primary healthcare services (1 month) compared with dedicated CDTCs (4 months) but healthcare system delay was higher (7 vs. 0 months) | |||
| – | 3. Good synergy between screening at first level and confirmation at specialized center/hospital is required | |||
| Tong J et al.50 | Debate | – | – | In conflict zones, integrated approaches may be not be feasible |
| Strategic plan PNLTHA55 | Policy paper | Coverage | F: Doctors, nurses, and laboratory staff were trained in endemic zones. Proportion of cases detected in fixed health services rose from 15% to 18% from 2007 to 2009 | – |
| Mitashi et al.52 | Systematic review | – | F: New diagnostic tools open perspectives for integrated screening | CATT and RDT are appropriate formats for HAT screening at first-level PHCs. No appropriate format for HAT confirmation available for this level |
| Hasker et al.42 | Viewpoint | Cost sustainability | O1: Long delays in PS | “Gradual and well-managed integration of the HAT control activities in the general health services can be envisaged, but this will require further research to identify the best strategies in low prevalence contexts. A minimal vertical approach to control the disease is likely to remain necessary.” |
| O2: More advance stage in PS | ||||
| O3: Low attendance rates | ||||
| Lejon48 | Editorial | – | O1 (related to specificity): High degree of cross-reactivity on other antibody detection tests (HIV, malaria) in HAT patients. | – |
| O2 (related to sensitivity): Reliance on RDTs in PHC centers will lead to missing HAT | ||||
| Control and surveillance of HAT WHO2 | Policy paper | The integration needs of the THA are satisfied by the arrival of the RDT-HAT | O: Insecurity, instability | Operational research is recommended to optimize passive screening |
| Franco et al.46 | Review | 1. Coverage | – | To reach elimination one has to combine three strategies: Active screening, passive screening and vector control, in the right mix, depending on epidemiological and health system context. |
| “Passive screening is the most important component for gambiense HAT control and surveillance in foci with low and very low intensity of transmission, where infection is rare and active case detection has poor cost-effectiveness. Passive screening is also a key element in high, very high and moderate transmission foci, as effectiveness of active screening is limited because of incomplete attendance at screening sessions, inherent limitations of screening tools and the lag between successive surveys.“ | ||||
| 2. Sustainability | ||||
| Franco et al.3 | Review | Sustainability | F: New diagnostic tools open perspectives for integrated screening | -Strengthening health system and increasing population awareness to implement the activities included in the elimination strategies is essential—sustained financial commitment |
| O: Weak peripheral healthcare system, understaffed and underequipped, with a low coverage or low attendance rate. | ||||
| Eperon et al.53 | Review article | – | O1: Current complexity of diagnostic algorithm | – |
| O2: Current stage two treatment regimen (NECT) is limited to hospital level and not adequate for the first line | ||||
| O3: Lack of trained staff and logistic resources in local health services most HAT-affected countries | ||||
| Simarro et al.12 | Capacity mapping survey (fixed health facilities offering DP) | 1. Enlarging physical coverage of screening through the network of fixed health centers | F: Knowledge of the disease by health staff and affected communities. | 1. More than 80% of the population at risk for Trypanosoma brucei gambiense HAT live within 5-hour travel of a fixed health facility offering diagnosis and treatment for HAT |
| O1: Weak laboratory capacity in rural health facilities | 2. A combination of active and passive screening is required | |||
| O2: Low attendance rates in some health facilities | 2. Currently (2000–2012), half of HAT cases in the world are reported from passive screening | |||
| Lumbala et al.13 | Analysis of routine HAT data reported to PNLTHA in DRC 2000–2012 | 1. National policy of health sector reform calls for integration | – | 1. Over the period 2000–2012, the proportion of all HAT cases detected by passive screening in DRC remained stable around 50%. |
| 2. Active screening needs to be maintained, in areas of intense transmission | ||||
| 2. The attendance rates in active screening remained fairly stable at 79% between 2000 and 2012. | ||||
| 3. Essential requirements for integrating HAT screening in the health center are : Functional and well-equipped health center, with adequate utilization rate, and trained and motivated staff | ||||
| 4. Express fear about loss of quality when integrating HAT screening in primary healthcare services compared with CDTC | ||||
| 5. Question whether integrated HAT screening is a mere consequence of disinvestment by international donors or a rational planned response to changing epidemiological context | ||||
| Simarro et al.51 | Analysis of global reported HAT data 2003–2012 | – | F: Suggesting new diagnostic and therapeutic tools will facilitate future integrated approaches | – |
| Mitashi et al.4 | Descriptive study of 43 primary healthcare centers in highly endemic areas in DRC | 1. Integrated screening is part of the WHO policy on HAT elimination. “Active case detection by mobile screening teams is to be conducted in all historic HAT foci until no more cases are detected at village level over a 5-year period. From that time onwards, screening should be shifted to passive, making use of existing general healthcare services.” | F1: HAT well-known by staff | 1. Integrated HAT screening in primary health centers requires not only specific HAT-related but also general strengthening of health services and increased utilization rates. |
| O1: Very low attendance rate of health centers (median two patients per day in the week preceding survey) | ||||
| O2. Poorly equipped centers. Only six of 9 CDTCs were fully equipped for HAT diagnosis and treatment. None of the 34 HCs was equipped for screening | ||||
| National policy on HAT control in DRC PNLTHA54 | Policy paper | – | – | Flexible approach to integration is required, adapted to local context of endemic provinces, operational capacity and epidemiological context |
| Aksoy et al.47 | Viewpoint | Cost Sustainability | – | In low endemicity areas, control strategies need to shift from active to passive screening in health centers |
| Kegels49 | PhD thesis | – | O: A lot of internal and external resistance toward integration leads to a very slow process | – |
CATT = card agglutination test for trypanosomiasis; CDTC = Centre de Diagnostic, Traitement et Contrôle; DRC = The Democratic Republic of the Congo; RDT = rapid diagnostic test; HAT = human African trypanosomiasis; PNLTHA = Programme National de Lutte contre la THA; PHC = primary healthcare; HC = health center. (Empty boxes means that the document you are viewing does not contain information related to the title of the column).