Barriers to integration of passive screening for sleeping sickness in Bibanga Health District, Democratic Republic of the Congo

Introduction The control of human African trypanosomiasis (HAT) relies primarily on the early detection and appropriate treatment of cases, which remain central components of current elimination strategies, while no vaccine or chemoprophylaxis is available. However, under-screening by mobile units is observed. Low HAT prevalence may lower motivation to participate in active screening programs that are important for early detection of cases, because people do not perceive the risk of infection. In this context, the integration of passive HAT screening into primary health services is encouraged but faces multiple challenges. This study aimed to explore the opinions and perceptions of the different actors involved in the integration of passive HAT screening into first level health establishments (Health Center and General Referral Hospital) in Bibanga Health District and identify the potential obstacles likely to affect it. Methods A qualitative study was conducted in four health areas, selected based on their performance in reporting passive screening (PS) activities and their geographical distance from the Central District Office. Thirteen focus group discussions (FGDs) were held with men, women, and young people, as well as twelve semi-structured interviews (SSIs) with former HAT patients, community volunteers (Presidents of the Health Committee), healthcare providers, and local and provincial decision-makers. The discussions were digitally recorded, transcribed, translated from Tshiluba into French, and thematically analyzed using ATLAS.ti 7.5.16 software. A documentary review was also carried out to complement the empirical data. Results Community perceptions indicate a limited knowledge about HAT, especially among young people, with confusion between HAT and malaria, fear of testing, and persistent rumors. Women expressed feelings of marginalization due to a lack of targeted information. On the provider side, demotivation is evident, linked to the absence of passive screening integration into official policies, lack of training, and lack of recognition. Community volunteer complained of a lack of support and motivation. The identified obstacles include: (i) structural barriers (geographical accessibility, stockouts, low attendance), (ii) economic constraints (medical expenses, transportation costs), (iii) sociocultural barriers (rumors, stigmatization), and (iv) institutional limitations (lack of supervision, low community involvement). Perception gaps have been noted between field actors and health authorities. Conclusion The integration of passive screening into primary healthcare programs requires a multisectoral approach tailored to the local context. Simplifying the diagnostic process would facilitate integration. However, the healthcare system must be adequately funded and equipped. These results offer concrete pathways to enhance the integration of passive screening and contribute to the elimination of HAT by 2030.