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Nogueira de Brito R, Tanner S, Runk JV, Hoyos J. Looking through the lens of social science approaches: A scoping review of leishmaniases and Chagas disease research. Acta Trop 2024; 249:107059. [PMID: 37918504 DOI: 10.1016/j.actatropica.2023.107059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Scholars have called for increased attention to sociocultural, economic, historical, and political processes shaping Neglected Tropical Diseases (NTDs) ecology. We conducted a scoping review to identify major research themes and the knowledge gaps in social science literature in leishmaniases or Chagas disease (CD). Following the scoping review protocol, we first determined the focus of the review to be centered on identifying research that approaches leishmaniases and CD from social science perspective and was indexed by large, biomedically focused databases. We then searched PubMed and Web of Science using "Leishmaniasis" and "Chagas disease" with "social science" or "anthropology" as search terms. We analyzed 199 articles (123 on leishmaniases and 76 on CD), categorizing them into three main research themes. Sociocultural dimensions of the diseases (leishmaniases=60.2 %; CD=68.4 %) primarily focused on individuals' knowledge, practices, and behaviors, barriers to accessing healthcare (especially in endemic regions), psychosocial effects, stigma, and traditional treatments. Research focused on socioeconomic dimensions of the diseases (leishmaniases=29.3 %; CD=19.7 %) included topics like household characteristics, social capital, and infrastructure access. A final theme, the historical and political contexts of the diseases (Leishmaniases=10.5 %; CD=11.9 %) was less common than other themes. Here, studies consider civil war and the (re)emergence of leishmaniasis, as well as the significance of CD discovery for scientific and public health in Brazil, which is the most common country for research on both leishmaniases and CD that draws on social science approaches. Future directions for research include focusing on how social institutions and economic factors shape diseases education, control measures, healthcare access, and quality of life of people affected by NTDs. Greater attention to social sciences can help mitigate and undo the ways that structural biases have infiltrated biomedicine.
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Affiliation(s)
- Raíssa Nogueira de Brito
- Department of Anthropology, University of Georgia, Athens, GA 30602, United States; Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, United States.
| | - Susan Tanner
- Department of Anthropology, University of Georgia, Athens, GA 30602, United States
| | - Julie Velásquez Runk
- Environment and Sustainability Studies Program, Wake Forest University, Winston Salem, NC 27109, United States; Smithsonian Tropical Research Institute, Balboa, Ciudad de Panamá 0843-03092, Republic of Panama
| | - Juliana Hoyos
- Odum School of Ecology, University of Georgia, Athens, GA 30602, United States
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Our Current Understanding of Chagas Disease and Trypanosoma cruzi Infection in the State of Florida — an Update on Research in this Region of the USA. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00261-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose of Review
Chagas disease (CD) is a neglected tropical disease caused by the protozoan parasite, Trypanosoma cruzi. Parasite transmission primarily occurs through direct interaction with an infected triatomine insect vector (kissing bug), but other routes are known. We aim to review the literature and discuss the unique circumstances of CD in the US state of Florida.
Recent Findings
Florida is home to naturally occurring kissing bugs that are invading homes and harbor T. cruzi. The state is also home to a diverse population of immigrants from Chagas-endemic regions in Latin America. In the USA, Florida is the state with the third highest estimated burden of CD, although the true prevalence is unknown.
Summary
Chagas disease is a chronic infection that often remains silent for decades. Those who manifest chronic disease may eventually die from debilitating cardiac and/or gastrointestinal manifestations. Florida is an opportune region of the USA for the study of CD, due to the existence of endemic transmission cycles in addition to the burden among people born in Chagas-endemic regions.
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On-site experience of a project to increase access to diagnosis and treatment of Chagas disease in high-risk endemic areas of Colombia. Acta Trop 2022; 226:106219. [PMID: 34757043 DOI: 10.1016/j.actatropica.2021.106219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
Colombia has one of the largest burdens of Chagas disease globally, with about 438,000 people affected according to 2015 estimates. Despite this, < 1% of the population has had access to diagnosis and treatment. A patient-centered roadmap for Chagas disease was developed from 2015 onwards to address access barriers and increase diagnostic and therapeutic coverage and was implemented in five municipalities where Chagas disease is endemic. The mean number of people tested per year increased from 37 before the project to 262 following implementation, and the average days between medical order and diagnostic confirmation results decreased from 258 to 19. The mean days from diagnostic confirmation to treatment initiation decreased from 354 before the project to 135 after implementation. The 5,654 people tested included 3,467 women of childbearing age. The prevalence of T. cruzi infection was 11.5%, and thus far 266 people have received antitrypanosomal treatment. Collaborative creation and implementation of a patient-centered roadmap can address access barriers in specific contexts, helping to reduce the invisibility and burden of this neglected disease.
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Iglesias-Rus L, Romay-Barja M, Boquete T, Benito A, Jordan B, Blasco-Hernández T. Mapping health behaviour related to Chagas diagnosis in a non-endemic country: Application of Andersen’s Behavioural Model. PLoS One 2022; 17:e0262772. [PMID: 35051245 PMCID: PMC8775331 DOI: 10.1371/journal.pone.0262772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Chagas disease has become a challenge for non-endemic countries since population mobility has increased in recent years and it has spread to these regions. In order to prevent vertical transmission and improve the prognosis of the disease, it is important to make an early diagnosis. And to develop strategies that improve access to diagnosis, it is important to know the factors that most influence the decision of the population to know their serological status. For this reason, this study uses Andersen’s Behavioural Model and its proposed strategies to explore the health behaviours of Bolivian population. Methods Twenty-three interviews, two focus groups, and two triangular groups were performed with Bolivian men and women, involving a total of 39 participants. In addition, four interviews were conducted with key informants in contact with Bolivian population to delve into possible strategies to improve the Chagas diagnosis. Results The most relevant facts for the decision to being diagnosed pointed out by participants were having relatives who were sick or deceased from Chagas disease or, for men, having their pregnant wife with a positive result. After living in Spain more than ten years, population at risk no longer feels identified with their former rural origin and the vector. Moreover, their knowledge and awareness about diagnosis and treatment still remains low, especially in younger people. Limitations on access to healthcare professionals and services were also mentioned, and proposed strategies focused on eliminating these barriers and educating the population in preventive behaviours. Conclusions Based on Andersen’s Behavioural Model, the results obtained regarding the factors that most influence the decision to carry out Chagas diagnosis provide information that could help to develop strategies to improve access to health services and modify health behaviours related to Chagas screening.
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Affiliation(s)
- Laura Iglesias-Rus
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Boquete
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | | | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- * E-mail:
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Sanmartino M, Forsyth CJ, Avaria A, Velarde-Rodriguez M, Gómez i Prat J, Albajar-Viñas P. The multidimensional comprehension of Chagas disease. Contributions, approaches, challenges and opportunities from and beyond the Information, Education and Communication field. Mem Inst Oswaldo Cruz 2022; 117:e200460. [DOI: 10.1590/0074-02760200460] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | | | - Mar Velarde-Rodriguez
- Swiss Tropical and Public Health Institute, Switzerland; University of Basel, Switzerland
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Carneiro Junior N, Aith F, Silva RAD, Wanderley DMV, Luna EJ, Shikanai-Yasuda MA. Access and right to health for Bolivian migrants in a Brazilian metropolis. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210761en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract This paper analyzes the health care accessibility conditions afforded to Bolivian immigrants in the Brazilian health system and their perception of the right to health. This was a cross-sectional, quantitative and qualitative study carried out from 2013 to 2015. Data were collected by a questionnaire with closed questions answered by 633 Bolivian individuals; questions regarding access to health were answered by 472 immigrants over 18 years old. Semi-structured interviews conducted with 55 subjects (Bolivians, health professionals, representatives of Health Departments, Consulate of Bolivia, Public Defender’s Office, Federal Public Prosecutor’s Office and Non-Governmental Organizations) underwent content analysis. Most Bolivian immigrants know the Brazilian National Health System (SUS) and often use Primary Health Care; however, they described structural and systemic barriers to health accessibility, such as lack of documentation, working conditions, medium and high complexity procedures, language barriers, among others. The National Health Card (CNS) is an important gateway to access health care, playing a role of social integration. Interviewees recognize health as a social right, pointing it out as a human and solidary value. Ensuring this recognition, when not based on the consolidation of social policies aimed at strengthening universal social protection, is threatened.
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Affiliation(s)
- Nivaldo Carneiro Junior
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil; Centro Universitário FMABC, Brasil
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Carneiro Junior N, Aith F, Silva RAD, Wanderley DMV, Luna EJ, Shikanai-Yasuda MA. Acesso e direito à saúde para migrantes bolivianos em uma metrópole brasileira. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210761pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Este artigo analisa as condições de acesso do imigrante boliviano ao sistema de saúde brasileiro e a percepção do direito à saúde. É um estudo transversal de metodologia quantitativa e qualitativa, realizado de 2013 a 2015. Foi elaborado um questionário com perguntas fechadas respondidas por 633 bolivianos, e em relação ao acesso à saúde por 472 indivíduos bolivianos maiores de 18 anos. A abordagem qualitativa foi feita por meio da análise de conteúdo de entrevistas semiestruturadas com 55 sujeitos (bolivianos, profissionais de saúde, representantes de Secretarias de Saúde, Consulado da Bolívia, Defensoria Pública da União, Ministério Público Federal e Organizações Não Governamentais). Os bolivianos conhecem o Sistema Único de Saúde (SUS) e utilizam com frequência a Atenção Primária à Saúde (APS). Todavia, barreiras de acesso são descritas, como falta de documentação, condições de trabalho, procedimentos de média e/ou alta complexidades, dificuldades para entenderem o que é dito assim como para serem compreendidos, entre outras. Sobressai-se a obtenção do Cartão Nacional de Saúde (CNS) como porta de entrada para o acesso à saúde, desempenhando papel de integração social. O reconhecimento da Saúde como direito social destaca-se entre os entrevistados, apontado como valor humano e solidário. A garantia desse reconhecimento fica ameaçada quando não se apoia na consolidação de políticas sociais que visem o fortalecimento da proteção social universal.
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Affiliation(s)
- Nivaldo Carneiro Junior
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil; Centro Universitário FMABC, Brasil
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McCall LI. mSphere of Influence: Forgotten Questions. mSphere 2021; 6:e0052021. [PMID: 34160240 PMCID: PMC8265670 DOI: 10.1128/msphere.00520-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Laura-Isobel McCall studies the relationship between location and disease pathogenesis, with a focus on infectious diseases and neglected diseases of poverty. In this mSphere of Influence article, she reflects on how three papers, "Opposing effects of fasting metabolism on tissue tolerance in bacterial and viral inflammation" (A. Wang, S. C. Huen, H. H. Luan, S. Yu, et al., Cell 166:1512-1525.e12, 2016, https://doi.org/10.1016/j.cell.2016.07.026), "Three-dimensional microbiome and metabolome cartography of a diseased human lung" (N. Garg, M. Wang, E. Hyde, R. R. da Silva, et al., Cell Host Microbe 22:705-716.e4, 2017, https://doi.org/10.1016/j.chom.2017.10.001), and "'It's like a phantom disease': patient perspectives on access to treatment for Chagas disease in the United States" (C. J. Forsyth, S. Hernandez, C. A. Flores, M. F. Roman, et al., Am J Trop Med Hyg 98:735-741, 2018, https://doi.org/10.4269/ajtmh.17-0691), shaped her spatial approach to infectious disease pathogenesis and helped her broaden her perspective from a pathogen-centric focus to a holistic view that include diseases tolerance mechanisms and barriers to health care access.
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Affiliation(s)
- Laura-Isobel McCall
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, Oklahoma, USA
- Department of Microbiology and Plant Biology, University of Oklahoma, Norman, Oklahoma, USA
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, Oklahoma, USA
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Valdez Tah AR. Making Sense of Chagas Disease among Mexican Immigrants in California. Med Anthropol 2021; 40:511-524. [PMID: 33798000 DOI: 10.1080/01459740.2021.1894560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mexican immigrants are affected by Chagas disease (CD) in California. It is through the representation of Chagas as a rare disease that participants make sense of the disease. A positive diagnosis has meant the disruption of patients' sense of normality and self-image, as well as their memories of homeland both reproducing and challenging hegemonic and stigmatized ideas of the disease associated with rurality and poverty. Access to treatment and medical care was the major coping mechanism. Health programs on CD should consider the emotional and social impact of the disease on people's self-perceptions to develop better medical care and prevention.
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Affiliation(s)
- Alba R Valdez Tah
- Peninsular Center of Humanities and Social Sciences, Autonomous University of Mexico (Centro Peninsular en Humanidades y Ciencias Sociales, UNAM), Mérida, México
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Forsyth CJ, Hernandez S, Flores CA, Roman MF, Nieto JM, Marquez G, Sequeira J, Sequeira H, Meymandi SK. "You Don't Have a Normal Life": Coping with Chagas Disease in Los Angeles, California. Med Anthropol 2021; 40:525-540. [PMID: 33784220 DOI: 10.1080/01459740.2021.1894559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chagas disease is the neglected tropical disease of greatest public health impact in the United States, where it affects over 300,000 people. Diverse barriers limit healthcare access for affected people; fewer than 1% have obtained testing or treatment. We interviewed 50 people with Chagas disease in Los Angeles, California, and administered a cultural consensus analysis questionnaire. Participants were asked about their experiences and perceptions of Chagas disease, access to healthcare, and strategies for coping with the disease. In participants' narratives, the physical and emotional impacts of the disease were closely interwoven. Participant explanatory models highlight difficulties in accessing care, despite a desire for biomedical treatment. Obtaining testing and treatment for Chagas disease poses substantial challenges for US patients.
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Affiliation(s)
- Colin J Forsyth
- Drugs for Neglected Diseases initiative-North America, New York, New York, USA.,Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Salvador Hernandez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Carmen A Flores
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Mario F Roman
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - J Maribel Nieto
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Grecia Marquez
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Juan Sequeira
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Harry Sequeira
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
| | - Sheba K Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, Sylmar, California, USA
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Stigler Granados P, Pacheco GJ, Núñez Patlán E, Betancourt J, Fulton L. Assessing the effectiveness of Chagas disease education for healthcare providers in the United States. BMC Infect Dis 2020; 20:743. [PMID: 33036559 PMCID: PMC7547496 DOI: 10.1186/s12879-020-05474-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chagas disease is a zoonotic infection caused by the parasite Trypanosoma cruzi, which affects an estimated 8-11 million people globally. Chagas disease is almost always associated with poverty in rural areas and disproportionately impacts immigrants from Latin America living in the United States. Approximately 20-30% of people who are infected with Chagas disease will develop a chronic form of the infection that can be fatal if left untreated. Chagas disease is vastly underestimated in the United States, often goes undiagnosed and is not well understood by most U.S. healthcare providers. One of the most important ways at reducing barriers to improving diagnostics of Chagas disease in the U.S. is giving healthcare providers the most up-to-date information and access to leading experts. METHODS An online webinar was conducted for healthcare providers, veterinarians and public health professionals using Chagas disease expert panelists. Pre and post tests were administered to participants (n = 57) to determine the efficacy in raising awareness and to determine key focus areas for improving knowledge. A Wilcoxon rank-sum was used for non-parametric variables equivalent and for questions that assessed knowledge the McNemar's Chi-Square test was used. RESULTS There were statistically significant learning increases in multiple categories including transmission (p = <.001), clinical presentation (p = 0.016), diagnostics (p = <.001), and treatment (p = <.001). CONCLUSION Providing easily accessible learning opportunities using validated testing and evaluations should be further developed for rural healthcare providers in the U.S. as well as healthcare providers serving under represented populations such as immigrants. There is a clear lack of knowledge and awareness surrounding Chagas disease in the United States and just by raising awareness and providing education on the topic, lives will be saved.
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Affiliation(s)
- Paula Stigler Granados
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Gerardo J. Pacheco
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Evangelina Núñez Patlán
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Jose Betancourt
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
| | - Lawrence Fulton
- School of Health Administration, Texas State University, 601 University Dr, San Marcos, TX 78666-4606 USA
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Iglesias Rodríguez IM, Mizukami S, Manh DH, Thuan TM, Justiniano HA, Miura S, Ito G, Huy NT, Smith C, Hirayama K. Knowledge, behaviour and attitudes towards Chagas disease among the Bolivian migrant population living in Japan: a cross-sectional study. BMJ Open 2020; 10:e032546. [PMID: 32928842 PMCID: PMC7490920 DOI: 10.1136/bmjopen-2019-032546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge, behaviour and attitudes towards Chagas disease (CD) among Latin American migrants in Japan and to evaluate the effectiveness of an educational activity (EA) in increasing knowledge of CD. DESIGN A cross-sectional, mixed-methods study employing a preknowledge and postknowledge test and focus group discussion, conducted from March 2018 to June 2018. PARTICIPANTS Seventy-two participants were included, all born in Bolivia and residents in four Japanese cities. Fifty-nine of them participated in the EA. INTERVENTIONS The EA comprised showing three videos about CD and a group discussion covering different dimensions of CD and was evaluated with questionnaires to analyse the knowledge of the participants before and after. RESULTS Seventy-two participants were enrolled, predominantly from highly endemic CD areas of Bolivia. Though most participants were familiar with vector-borne transmission, epidemiology and symptomatology of CD, the baseline knowledge of CD was low. Less than 10% of them had been tested prior for CD. The dominant factors associated with better knowledge were living in Japan for more than 10 years (OR=8.42, 95% CI 1.56 to 48.62) and previously testing for CD (OR=11.32; 95% CI 1.52 to 105.9). The EA significantly improved the CD knowledge of the participants (p value <0.0001; 95% CI 2.32 to 3.84). The participants associated the term 'Chagas' mostly with fear and concern. The level of stigmatisation was low, in contrast to the results of other studies. The barriers encountered in care-seeking behaviour were language, the migration process and difficulties to access the healthcare system. CONCLUSION EA with an integrative approach is useful to increase the knowledge of CD within the Bolivian migrant population living in Japan. The activity brings the possibility to explore not only the level of knowledge but also to reveal experiences and to understand the needs of the people at risk. Considering them as actors towards healthcare solutions could lead to better outcomes for the success of future policies and interventions aimed to decrease the global burden.
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Affiliation(s)
| | - Shusaku Mizukami
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Dao Huy Manh
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tieu Minh Thuan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sachio Miura
- NPO organization. MAIKEN. Motohachiojimachi, Hachioji-shi, Tokyo, Japan
| | - George Ito
- Consulate General of Brazil in Japan, Shinagawa-ku, Tokyo, Japan
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Perez-Zetune V, Bialek SR, Montgomery SP, Stillwaggon E. Congenital Chagas Disease in the United States: The Effect of Commercially Priced Benznidazole on Costs and Benefits of Maternal Screening. Am J Trop Med Hyg 2020; 102:1086-1089. [PMID: 32100696 PMCID: PMC7204569 DOI: 10.4269/ajtmh.20-0005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chagas disease, caused by Trypanosoma cruzi, is transmitted by insect vectors, and through transfusions, transplants, insect feces in food, and mother to child during gestation. An estimated 30% of infected persons will develop lifelong, potentially fatal cardiac or digestive complications. Treatment of infants with benznidazole is highly efficacious in eliminating infection. This work evaluates the costs of maternal screening and infant testing and treatment for Chagas disease in the United States, including the cost of commercially available benznidazole. We compare costs of testing and treatment for mothers and infants with the lifetime societal costs without testing and consequent morbidity and mortality due to lack of treatment or late treatment. We constructed a decision-analytic model, using one tree that shows the combined costs for every possible mother–child pairing. Savings per birth in a targeted screening program are $1,314, and with universal screening, $105 per birth. At current screening costs, universal screening results in $420 million in lifetime savings per birth-year cohort. We found that a congenital Chagas screening program in the United States is cost saving for all rates of congenital transmission greater than 0.001% and all levels of maternal prevalence greater than 0.06% compared with no screening program.
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Affiliation(s)
| | - Stephanie R Bialek
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Silva RAD, Wanderley DMV, Forsyth C, Leite RM, Luna EJDA, Carneiro Júnior N, Shikanai-Yasuda MA. Awareness of Chagas disease and socioeconomic characteristics of Bolivian immigrants living in Sao Paulo, Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e39. [PMID: 32578725 PMCID: PMC7304264 DOI: 10.1590/s1678-9946202062039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/18/2020] [Indexed: 11/29/2022] Open
Abstract
In this study which is part of a research project on Chagas disease (CD) among Bolivian immigrants in Sao Paulo, we describe socioeconomic characteristics, knowledge of CD and implications for acess to health care. We applied a structured questionnaire to a sample of 472 Bolivian adults (> 18 years) living in Sao Paulo and enrolled at the Barra Funda School Health Center. Participants’ median age was 28.5 years, 75.0% were from the Bolivian department of La Paz, and >90% worked in the garment industry. Respondents had lived in Sao Paulo for a median of 5.8 years. Only 169 (35.8%) were familiar with CD, while roughly half (50.4%) had lived in natural materials houses in Bolivia, 225 (47.7%) indicated familiarity with the vector, 23.9% had seen the vector in their homes in Bolivia, and 6.4% reported having been bitten by a triatomine bug. Factors associated with awareness of CD were analyzed by chi square tests, and those with p values <0.25 were included in a multivariable logistic regression model. In the multivariable logistic regression analysis, having a relative with CD (OR=4.3, 95% CI=1.5-12.0), having lived in a house with mud or wood walls (OR=0.4, 95% CI=0.2-0.8), and having heard of the triatomine bug, or vinchuca, (OR=10.0, 95% CI=5.1-19.5) were significantly associated with awareness of CD. This study shows a low familiarity with CD among Bolivian migrants living in Sao Paulo, Brazil. Raising awareness of the disease through specific communication strategies should be an essential component of public health programs to reduce the burden of CD in this and other vulnerable populations.
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Affiliation(s)
- Rubens Antonio da Silva
- Secretaria de Estado da Saúde de São Paulo, Superintendência de Controle de Endemias, São Paulo, Brazil
| | | | - Colin Forsyth
- Drugs for Neglected Diseases iniciative (DNDi), Geneva, Switzerland
| | - Ruth Moreira Leite
- Secretaria de Estado da Saúde de São Paulo, Centro de Vigilância Epidemiológica, São Paulo, São Paulo, Brazil
| | | | | | - Maria Aparecida Shikanai-Yasuda
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, Laboratório de Investigação Médica em Imunologia (LIM-48), São Paulo, São Paulo, Brazil
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15
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Yoshioka K, Manne-Goehler J, Maguire JH, Reich MR. Access to Chagas disease treatment in the United States after the regulatory approval of benznidazole. PLoS Negl Trop Dis 2020; 14:e0008398. [PMID: 32569280 PMCID: PMC7347212 DOI: 10.1371/journal.pntd.0008398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 07/09/2020] [Accepted: 05/18/2020] [Indexed: 01/06/2023] Open
Abstract
Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease, but less than 1% are estimated to have received antiparasitic treatment. Benznidazole was approved by the US Food and Drug Administration (FDA) for treatment of T. cruzi infection in 2017 and commercialized in May 2018. This paper analyzes factors that affect access to benznidazole following commercialization and suggests directions for future actions to expand access. We applied an access framework to identify barriers, facilitators, and key actors that influence the ability of people with Chagas disease to receive appropriate treatment with benznidazole. Data were collected from the published literature, key informants, and commercial databases. We found that the mean number of persons who obtained benznidazole increased from just under 5 when distributed by the CDC to 13 per month after the commercial launch (from May 2018 to February 2019). Nine key barriers to access were identified: lack of multi-sector coordination, failure of health care providers to use a specific order form, lack of an emergency delivery system, high medical costs for uninsured patients, narrow indications for use of benznidazole, lack of treatment guidelines, limited number of qualified treaters, difficulties for patients to make medical appointments, and inadequate evaluation by providers to determine eligibility for treatment. Our analysis shows that access to benznidazole is still limited after FDA approval. We suggest six areas for strategic action for the pharmaceutical company that markets benznidazole and its allied private foundation to expand access to benznidazole in the US. In addition, we recommend expanding the existing researcher-clinician network by including government agencies, companies and others. This paper's approach could be applied to access programs for benznidazole in other countries or for other health products that target neglected populations throughout the world.
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Affiliation(s)
- Kota Yoshioka
- Doctor of Public Health Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James H. Maguire
- Division of Infectious Disease, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael R. Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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16
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Zheng C, Quintero O, Revere EK, Oey MB, Espinoza F, Puius YA, Ramirez-Baron D, Salama CR, Hidalgo LF, Machado FS, Saeed O, Shin J, Patel SR, Coyle CM, Tanowitz HB. Chagas Disease in the New York City Metropolitan Area. Open Forum Infect Dis 2020; 7:ofaa156. [PMID: 32500090 PMCID: PMC7255644 DOI: 10.1093/ofid/ofaa156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Chagas disease, caused by the parasite Trypanosoma cruzi, once considered a disease confined to Mexico, Central America, and South America, is now an emerging global public health problem. An estimated 300 000 immigrants in the United States are chronically infected with T. cruzi. However, awareness of Chagas disease among the medical community in the United States is poor. Methods We review our experience managing 60 patients with Chagas disease in hospitals throughout the New York City metropolitan area and describe screening, clinical manifestations, EKG findings, imaging, and treatment. Results The most common country of origin of our patients was El Salvador (n = 24, 40%), and the most common detection method was by routine blood donor screening (n = 21, 35%). Nearly half of the patients were asymptomatic (n = 29, 48%). Twenty-seven patients were treated with either benznidazole or nifurtimox, of whom 7 did not complete therapy due to side effects or were lost to follow-up. Ten patients had advanced heart failure requiring device implantation or organ transplantation. Conclusions Based on our experience, we recommend that targeted screening be used to identify at-risk, asymptomatic patients before progression to clinical disease. Evaluation should include an electrocardiogram, echocardiogram, and chest x-ray, as well as gastrointestinal imaging if relevant symptoms are present. Patients should be treated if appropriate, but providers should be aware of adverse effects that may prevent patients from completing treatment.
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Affiliation(s)
- Crystal Zheng
- Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Orlando Quintero
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Elizabeth K Revere
- Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell University, Manhasset, New York, USA
| | - Michael B Oey
- Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell University, Manhasset, New York, USA
| | - Fabiola Espinoza
- Metro Infectious Diseases Consultants, Burr Ridge, Illinois, USA
| | - Yoram A Puius
- Division of Infectious Diseases, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Carlos R Salama
- Division of Infectious Diseases, Elmhurst Hospital Center-Icahn School of Medicine at the Mount Sinai Hospital, Queens, New York, USA
| | - Luis F Hidalgo
- Division of Cardiovascular Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | | | - Omar Saeed
- Division of Cardiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jooyoung Shin
- Division of Cardiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York, USA
| | - Snehal R Patel
- Division of Cardiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christina M Coyle
- Division of Infectious Diseases, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA.,Division of Parasitology, Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Herbert B Tanowitz
- Division of Infectious Diseases, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, New York, USA.,Division of Parasitology, Department of Pathology, Albert Einstein College of Medicine, Bronx, New York, USA
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17
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Chagas Disease and Healthcare Rights in the Bolivian Immigrant Community of São Paulo, Brazil. Trop Med Infect Dis 2020; 5:tropicalmed5020062. [PMID: 32316420 PMCID: PMC7345312 DOI: 10.3390/tropicalmed5020062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Chagas disease (CD) poses a major public health challenge for the Americas and non endemic regions around the world. This study discusses the legal framework surrounding access to healthcare for CD for Bolivian migrants living in São Paulo, Brazil. While recent guidelines stipulating care for CD exist, there is a lack of legal provisions to ensure they are regularly implemented. Bolivian migrants in SP have specific needs, including language differences and a high level of mobility. Interviews were conducted with ten participants representing public health institutions or organizations working with the Bolivian migrant community. Additionally, a review was conducted of legal, official, and health policy documents pertaining to rights of Bolivian migrants in SP. Although the right to healthcare is constitutionally guaranteed for all, in practice, immigrants, especially those without documentation, encounter barriers to initiating treatment for CD. Providing the primary health care system (SUS) card would not only improve access to healthcare for Bolivian migrants, but also provide a potential pathway toward regularization of status. The approval of clinical protocols and therapeutic guidelines for CD (2018) represents an opportunity to improve care for all Brazilians with CD. Programs with multidisciplinary teams should be developed taking into account the specific social and cultural needs of this population.
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18
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Echeverría LE, Marcus R, Novick G, Sosa-Estani S, Ralston K, Zaidel EJ, Forsyth C, RIbeiro ALP, Mendoza I, Falconi ML, Mitelman J, Morillo CA, Pereiro AC, Pinazo MJ, Salvatella R, Martinez F, Perel P, Liprandi ÁS, Piñeiro DJ, Molina GR. WHF IASC Roadmap on Chagas Disease. Glob Heart 2020; 15:26. [PMID: 32489799 PMCID: PMC7218776 DOI: 10.5334/gh.484] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Chagas Disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, with some of the most serious manifestations affecting the cardiovascular system. It is a chronic, stigmatizing condition, closely associated with poverty and affecting close to 6 million people globally. Although historically the disease was limited to endemic areas of Latin America recent years have seen an increasing global spread. In addition to the morbidity and mortality associated with the disease, the social and economic burdens on individuals and society are substantial. Often called the 'silent killer', Chagas disease is characterized by a long, asymptomatic phase in affected individuals. Approximately 30% then go on develop chronic Chagas cardiomyopathy and other serious cardiac complications such as stroke, rhythm disturbances and severe heart failure. Methods In a collaboration of the World Hearth Federation (WHF) and the Inter-American Society of Cardiology (IASC) a writing group consisting of 20 diverse experts on Chagas disease (CD) was convened. The group provided up to date expert knowledge based on their area of expertise. An extensive review of the literature describing obstacles to diagnosis and treatment of CD along with proposed solutions was conducted. A survey was sent to all WHF Members and, using snowball sampling to widen the consultation, to a variety of health care professionals working in the CD global health community. The results were analyzed, open comments were reviewed and consolidated, and the findings were incorporated into this document, thus ensuring a consensus representation. Results The WHF IASC Roadmap on Chagas Disease offers a comprehensive summary of current knowledge on prevention, diagnosis and management of the disease. In providing an analysis of 'roadblocks' in access to comprehensive care for Chagas disease patients, the document serves as a framework from which strategies for implementation such as national plans can be formulated. Several dimensions are considered in the analysis: healthcare system capabilities, governance, financing, community awareness and advocacy. Conclusion The WHF IASC Roadmap proposes strategies and evidence-based solutions for healthcare professionals, health authorities and governments to help overcome the barriers to comprehensive care for Chagas disease patients. This roadmap describes an ideal patient care pathway, and explores the roadblocks along the way, offering potential solutions based on available research and examples in practice. It represents a call to action to decision-makers and health care professionals to step up efforts to eradicate Chagas disease.
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Affiliation(s)
| | - Rachel Marcus
- LASOCHA, Washington DC, US
- Medstar Union Memorial Hospital, Baltimore, MD, US
| | - Gabriel Novick
- Swiss Medical Group, Buenos Aires, AR
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, US
| | - Sergio Sosa-Estani
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, BR
| | | | - Ezequiel Jose Zaidel
- Sanatorio Güemes, Buenos Aires, AR
- Pharmacology Department, School of Medicine, University of Buenos Aires, Buenos Aires, AR
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative-Latin America, Rio de Janeiro, BR
| | - Antonio Luiz P. RIbeiro
- Internal Medicine Department, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, BR
- Hospital das Clínicas, UFMG, Belo Horizonte, BR
| | | | - Mariano Luis Falconi
- Cardiology Division, Italian Hospital of Buenos Aires, Buenos Aires, AR
- University Institute of the Italian Hospital of Buenos Aires, Buenos Aires, AR
| | - Jorge Mitelman
- Faculty of Medicine, University of Buenos Aires, Buenos Aires, AR
- School of Medicine, Barcélo University, Buenos Aires, AR
| | - Carlos A. Morillo
- Department of Cardiac Sciences, Cumming School of Medicine Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, CA
- Southeastern Alberta Region, Alberta Health Services, Foothills Medical Centre, CA
| | | | | | | | - Felipe Martinez
- National University of Cordoba, Cordoba, AR
- DAMIC Institute/Rusculleda Foundation, Cordoba, AR
| | - Pablo Perel
- World Heart Federation, Geneva, CH
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, GB
| | - Álvaro Sosa Liprandi
- Sanatorio Güemes, Buenos Aires, AR
- Medical School of Cardiology, University of Buenos Aires, Buenos Aires, AR
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19
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Pinazo MJ, Pereiro A, Herazo R, Chopita M, Forsyth C, Lenardón M, Losada I, Torrico F, Marchiol A, Vera M. Interventions to bring comprehensive care to people with Chagas disease: Experiences in Bolivia, Argentina and Colombia. Acta Trop 2020; 203:105290. [PMID: 31811865 DOI: 10.1016/j.actatropica.2019.105290] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 11/14/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
Chagas disease (CD) affects over six million people and is a leading cause of heart failure in the Americas. Few are able to access diagnosis and treatment for CD, resulting in a missed opportunity to prevent morbimortality. Integration of testing and treatment with the primary healthcare level is a key step in ensuring affected people receive timely antitrypansomal therapy, which increasing evidence shows can prevent chronic complications from the disease and halt congenital transmission. This article describes three collaborative projects focused on increasing access to testing and treatment for CD through primary healthcare facilities in Bolivia, Argentina, and Colombia.
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Affiliation(s)
| | - Ana Pereiro
- Fundacion Mundo Sano, Buenos Aires, Argentina, Madrid, Spain.
| | - Rafael Herazo
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil.
| | - Marina Chopita
- Secretariat of Health and Social Medicine of the Municipality of La Plata, Argentina
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Mabel Lenardón
- Secretariat of Health and Social Medicine of the Municipality of La Plata, Argentina
| | - Irene Losada
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Faustino Torrico
- Universidad Mayor de San Simón, Faculty of Medicine, Cochabamba, Bolivia; Fundación CEADES, Cochabamba, Bolivia
| | - Andrea Marchiol
- Drugs for Neglected Diseases initiative, Rio de Janeiro, Brazil
| | - Mauricio Vera
- Ministry of Health and Social Protection, Bogotá, Colombia
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20
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Velasco M, Gimeno-Feliú LA, Molina I, Salas-Coronas J, Solà I, Monge-Maillo B, Torrús-Tendero D, Caylà J, de Guzmán EN, Arellano JLP, Pérez-Molina JA. Screening for Trypanosoma cruzi infection in immigrants and refugees: Systematic review and recommendations from the Spanish Society of Infectious Diseases and Clinical Microbiology. Euro Surveill 2020; 25:1900393. [PMID: 32127121 PMCID: PMC7055039 DOI: 10.2807/1560-7917.es.2020.25.8.1900393] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundChagas disease has spread beyond its original borders on the American continent with migration. It can be transmitted from mother to child, through organ transplantation and transfusion of blood and blood products. It is necessary to determine when to screen for this infection.AimOur objective was to evaluate the appropriateness of screening for Trypanosoma cruzi infection in Latin American migrants and their descendants.MethodsWe reviewed the literature using rigorous criteria. The quality of evidence was ranked according to the GRADE classification. An evidence to decision framework was adopted to provide information on the most relevant aspects necessary to formulate recommendations.ResultsThe 33 studies evaluated revealed a prevalence of T. cruzi infection among Latin American migrants in Europe of 6.08% (95% confidence interval (CI): 3.24-9.69; 28 studies). Vertical transmission occurred in three of 100 live births (95% CI: 1-6; 13 studies). The prevalence of cardiovascular disease was 19% (95% CI: 13-27; nine studies), including only 1% severe cardiac events (95% CI: 0-2; 11 studies). The overall quality of evidence was low because of risk of bias in the studies and considerable heterogeneity of the evaluated populations. The recommendations took into account economic studies on the value of screening strategies and studies on acceptability of screening and knowledge of the disease in the affected population.ConclusionsWe identified five situations in which screening for T. cruzi infection is indicated. We recommend screening persons from endemic areas and children of mothers from these areas.
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Affiliation(s)
- María Velasco
- Infectious and Tropical Medicine Section, Internal Medicine Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Luis Andrés Gimeno-Feliú
- San Pablo Health Centre, Zaragoza, Spain,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain,Health Services Research on Chronic Patients Network (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Begoña Monge-Maillo
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Diego Torrús-Tendero
- Referral Unit for Imported Infections and International Health. Infectious Diseases Unit, Hospital General Universitario de Alicante. Parasitology Area, Miguel Hernández University, Alicante, Spain
| | - Joan Caylà
- Fundació de la Unitat d'Investigació en Tuberculosis (FuiTB), TB Research Unit, Barcelona, Spain
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - JL Pérez Arellano
- Infectious Diseases and Tropical Medicine Unit, Hospital Insular de Las Palmas. Las Palmas de Gran Canaria, Spain,Medical and Surgical Sciences Department. Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jose A Pérez-Molina
- National Referral Centre for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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21
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Ventura-Garcia L, Muela-Ribera J, Martínez-Hernáez A. Chagas, Risk and Health Seeking among Bolivian Women in Catalonia. Med Anthropol 2020; 40:541-556. [PMID: 32058805 DOI: 10.1080/01459740.2020.1718125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this article, we explore relationships between risk and emotions among Bolivian women living with Chagas disease, and the implications of this for their diagnosis and treatment in Catalonia, Spain. Here, risk is a social phenomenon, while emotions are conceived as embedded in the sociocultural and relational world. Emotions play key risk-related roles as both a cause and consequence of Chagas disease, are the basis of health practices, and allow us to link risk to wider social inequalities. The way we conceive emotions is crucial both theorically and practically.
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Affiliation(s)
- Laia Ventura-Garcia
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Joan Muela-Ribera
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
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22
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Bern C, Messenger LA, Whitman JD, Maguire JH. Chagas Disease in the United States: a Public Health Approach. Clin Microbiol Rev 2019; 33:e00023-19. [PMID: 31776135 PMCID: PMC6927308 DOI: 10.1128/cmr.00023-19] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Trypanosoma cruzi is the etiological agent of Chagas disease, usually transmitted by triatomine vectors. An estimated 20 to 30% of infected individuals develop potentially lethal cardiac or gastrointestinal disease. Sylvatic transmission cycles exist in the southern United States, involving 11 triatomine vector species and infected mammals such as rodents, opossums, and dogs. Nevertheless, imported chronic T. cruzi infections in migrants from Latin America vastly outnumber locally acquired human cases. Benznidazole is now FDA approved, and clinical and public health efforts are under way by researchers and health departments in a number of states. Making progress will require efforts to improve awareness among providers and patients, data on diagnostic test performance and expanded availability of confirmatory testing, and evidence-based strategies to improve access to appropriate management of Chagas disease in the United States.
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Affiliation(s)
- Caryn Bern
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Jeffrey D Whitman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - James H Maguire
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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Batista C, Forsyth CJ, Herazo R, Certo MP, Marchiol A. A four-step process for building sustainable access to diagnosis and treatment of Chagas disease. Rev Panam Salud Publica 2019; 43:e74. [PMID: 31582959 PMCID: PMC6758842 DOI: 10.26633/rpsp.2019.74] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/16/2019] [Indexed: 02/04/2023] Open
Abstract
The vast majority of people with Chagas disease (CD) are undiagnosed and untreated. Improving access to diagnosis and treatment for CD involves confronting a wide range of barriers. This report discusses a collaborative approach to eliminate barriers and increase the availability of CD testing and treatment. Potential areas for intervention are selected based on burden of disease, support of local champions, and commitment from national and local authorities. A 4D approach (diagnose, design, deliver, and demonstrate impact) is then implemented. The diagnose step involves gathering key stakeholders at a seminar to collaboratively identify important barriers and propose solutions. The design step creates a specific plan to act upon the seminar’s conclusions with consensus on core indicators. The deliver step entails implementing the plan at pilot locations, while simultaneously strengthening health system capacity for CD testing and treatment. Lastly, the demonstrate impact step compares baseline data with annual post-implementation data to measure progress. In Colombia, this approach has helped simplify testing procedures and increase CD testing and treatment access in pilot communities, though challenges remain. The 4D approach represents one of several pathways toward ensuring that the best therapeutic and diagnostic products reach people affected by neglected tropical diseases.
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Affiliation(s)
- Carolina Batista
- Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Geneva Switzerland Drugs for Neglected Diseases initiative, Chagas Treatment Access Project, Geneva, Switzerland
| | - Colin J Forsyth
- Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Geneva Switzerland Drugs for Neglected Diseases initiative, Chagas Treatment Access Project, Geneva, Switzerland
| | - Rafael Herazo
- Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Geneva Switzerland Drugs for Neglected Diseases initiative, Chagas Treatment Access Project, Geneva, Switzerland
| | - Marina Pereira Certo
- Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Geneva Switzerland Drugs for Neglected Diseases initiative, Chagas Treatment Access Project, Geneva, Switzerland
| | - Andrea Marchiol
- Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Drugs for Neglected Diseases initiative, Chagas Treatment Access Project Geneva Switzerland Drugs for Neglected Diseases initiative, Chagas Treatment Access Project, Geneva, Switzerland
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24
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Forsyth C, Meymandi S, Moss I, Cone J, Cohen R, Batista C. Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States. PLoS Negl Trop Dis 2019; 13:e0007447. [PMID: 31557155 PMCID: PMC6762052 DOI: 10.1371/journal.pntd.0007447] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world's most advanced healthcare systems? METHODOLOGY/PRINCIPAL FINDINGS This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma. CONCLUSIONS We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
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Affiliation(s)
- Colin Forsyth
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | - Ilan Moss
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
| | - Jason Cone
- Médecins sans Frontières/Doctors Without Borders USA, New York, New York, United States of America
| | - Rachel Cohen
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
| | - Carolina Batista
- Drugs for Neglected Diseases initiative, Latin America, Rio de Janeiro, Brazil
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25
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Current Gaps and Needs for Increasing Access to Healthcare for People with Chagas Disease in the USA. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-0170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Müller Kratz J, Garcia Bournissen F, Forsyth CJ, Sosa-Estani S. Clinical and pharmacological profile of benznidazole for treatment of Chagas disease. Expert Rev Clin Pharmacol 2018; 11:943-957. [DOI: 10.1080/17512433.2018.1509704] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jadel Müller Kratz
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
| | - Facundo Garcia Bournissen
- Parasitology and Chagas Service, Buenos Aires Children Hospital Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Colin J. Forsyth
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
| | - Sergio Sosa-Estani
- Chagas Clinical Program, Drugs for Neglected Disease initiative (DNDi), Geneva, Switzerland
- Epidemiology and Public Health Research Center, CONICET, Buenos Aires, Argentina
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