Centering patient expectations of a novel home-based oral drug treatment among 'T. b. rhodesiense' human African Trypanosomiasis patients in Uganda

The recent approval of fexinidazole for human African trypanosomiasis (HAT) caused by 'T. b. gambiense' enables improved patient management that is pivotal to elimination. Effective in both the early and late stages of the disease, it obviates the need for invasive lumbar punctures which g...

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Published in:	Tropical medicine and infectious disease Vol. 5; no. 1; pp. 1 - 13
Main Authors:	Lee, Shona J, Apio, Renah J, Palmer, Jennifer J
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 01-03-2020 MDPI
Subjects:	African trypanosomiasis Analysis Antiparasitic agents Care Drug therapy elimination fexinidazole Home care home-based treatment human africa trypanosomiasis Medical protocols Methods Patient compliance Patient outcomes Patient-centered health care patient-centred care Patients uganda World Health Organization Uganda home-based treatment Uganda fexinidazole human Africa trypanosomiasis elimination patient-centred care
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Summary:	The recent approval of fexinidazole for human African trypanosomiasis (HAT) caused by 'T. b. gambiense' enables improved patient management that is pivotal to elimination. Effective in both the early and late stages of the disease, it obviates the need for invasive lumbar punctures which guide therapy, in some patients. Unlike existing injectable treatments requiring systematic hospitalisation, fexinidazole's oral administration will allow many patients to be treated in an outpatient or home-based setting. Drawing on interviews with 25 'T. b. rhodesiense' HAT patients managed under existing protocols in Uganda where trials of fexinidazole will begin shortly, this article explores patient expectations of the new protocol to help HAT programmes anticipate patient concerns. Alongside frightening symptoms of this life-threatening illness, the pain and anxiety associated with lumbar punctures and intravenous injections of melarsoprol contributed to a perception of HAT as a serious illness requiring expert medical care. While preferring a new protocol that would avoid these uncomfortable procedures, patients' trust in the care they received meant that nearly half were hesitant towards shifting care out of the hospital setting. Clinical observation is an important aspect of existing HAT care for patients. Programmes may need to offer extensive counselling and monitoring support before patients are comfortable accepting care outside of hospitals.
Bibliography:	Tropical Medicine and Infectious Disease, Vol. 5, No. 1, Mar 2020: 1-13 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2414-6366 2414-6366
DOI:	10.3390/tropicalmed5010016