@article{fdi:010076114,
  title = {{S}creening, diagnosis and care cascade for viral hepatitis {B} and {C} in {Y}aounde, {C}ameroon : a qualitative study of patients and health providers coping with uncertainty and unbearable costs},
  author = {{C}habrol, {F}anny and {N}oah, {D}. {N}. and {T}choumi, {E}. {P}. and {V}idal, {L}aurent and {K}uaban, {C}. and {C}arrieri, {M}. {P}. and {B}oyer, {S}. and {M}arch, {L}aura and {L}aurent, {C}hristian and {L}i{\'e}geois, {F}lorian and {E}ymard {D}uvernay, {S}abrina and {EVOLC}am {G}roup},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives {T}o 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 {C}ameroon, an endemic country in sub-{S}aharan {A}frica. {D}esign {Q}ualitative sociological study combining in-depth interviews and observations of medical consultations. {I}nterviews 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. {S}etting {HIV} and gastroenterology/medical services in two reference public hospitals in {Y}aounde ({C}ameroon). {P}articipants 12 patients affected by {HBV} and/or {HCV} (co-infected or not with {HIV}), 14 {HCP}, 14 state and international stakeholders. {F}indings {M}any patients are screened for {HBV} and {HCV} at a time of great emotional and economic vulnerability. {T}he information and counselling delivered after diagnosis is limited and patients report feeling alone, distressed and unprepared to cope with their infection. {A}fter 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. {T}hese costs are so exorbitant that many decide against clinical and biological follow-up. {F}or those who do pay, the consequences on their social and economic life trajectories are catastrophic. {C}onclusion {L}arge out-of-pocket expenditures related to biological follow-up and treatment pose a real challenge to receiving appropriate care. {F}ree 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.},
  keywords = {{CAMEROUN}},
  booktitle = {},
  journal = {{BMJ} {O}pen},
  volume = {9},
  numero = {3},
  pages = {art. no e025415 [11 ]},
  ISSN = {2044-6055},
  year = {2019},
  DOI = {10.1136/bmjopen-2018-025415},
  URL = {https://www.documentation.ird.fr/hor/fdi:010076114},
}