442. The Results of a Primary Care-based Screening Program for Trypanosoma cruzi in East Boston, Massachusetts

Abstract

BackgroundThis study reports the outcomes of the Strong Hearts pilot project to integrate screening for Trypanosoma cruzi into a primary care setting and facilitate referral for treatment at East Boston Neighborhood Health Center.MethodsContinuing education about Chagas disease was offered to healthcare providers, and community-based outreach was provided. One-time screening for all patients ≤50 years old who lived in Mexico, South or Central America for ≥6 months was recommended. The initial screening test was an ELISA performed by a commercial laboratory and confirmatory testing was performed at the US CDC. Confirmed positives were defined as positive on both the screening and confirmatory tests. Confirmed positive patients were referred to the Pediatric and Adult Infectious Disease clinics at Boston Medical Center for further evaluation and treatment. We compared the proportion of confirmed positives by sex, age, and self-reported national origin using chi-squared tests. We then used multivariable logistic regression to examine predictors of (1) confirmed positive or (2) discordant screening and confirmatory testing.ResultsA total of 2,183 screening tests were sent; 84 (3.8%) were positive, 2,082 (95.4%) negative, and 17 (0.8%) indeterminate. Among 73 tests with confirmatory results available, 19 (26%) were positive and 54 (74%) negative. All indeterminate tests were confirmed negative. The proportion of confirmed positives increased with increasing age (P = 0.014) (Table 1), but there were no significant differences by sex (M: 8/757, F: 11/1,413, P = 0.51) or national origin (P = 0.79). Nineteen confirmed positives have been evaluated and six initiated benznidazole to date. Three confirmed positives were pregnant. In multivariable models, there were no significant predictors of confirmed positive or discordant testing.ConclusionThis pilot shows that integration of screening for Chagas disease is feasible in primary care. Although the prevalence of T. cruzi infection was higher in older age groups, there were no clear demographic predictors of a confirmed positive or discordant test. We also found a high false-positive rate of the screening test, highlighting the need for improved serologic testing options.Table 1.Age Group (Years)Positive Cases (#)*Total Screened (#)Prevalence (%)≤1901010.020–2937420.430–3978200.940–4953921.3≥5041153.5Disclosures All authors: No reported disclosures.

Chagas Disease in the United States: a Public Health Approach

“…Current practice in Latin America prioritizes diagnosis and treatment of children 15 years old or younger, but the vast majority of infected individuals in the United States are adults. In the sparse available community screening data, the T. cruzi prevalence in Latin American adults 40 years or younger was 0.64 to 0.95% compared to 1.42 to 1.78% among those older 40 years(280,281). In limited community screening to date, no infections have been detected among children(281).Tertiary prevention has had a major impact on the survival and quality of life of persons living with T. cruzi infection in Latin America(340), and the experience of a dedicated center of excellence based in the cardiology service of a large Los Angeles hospital confirms this model in the United States (310, 311, 341-343).…”

Chagas Disease in Pregnant Women from Endemic Regions Attending the Hospital General de Mexico, Mexico City

“…Our study showed that while overall disease prevalence is low, in selected groups, there is a need to initiate screening and follow-up processes when appropriate. Another primary care-based screening pilot program in Boston found 3.8% positive screening tests, demonstrating the feasibility of incorporation of CD screening in primary care in non-endemic settings [45]. Custom-made interdisciplinary initiatives that align with local goals and health projects are feasible, effective, and should be promoted to screen as many people as cost-effectively as possible in primary care settings.…”

Seroprevalence of Chagas Disease Among Latin American Children Living in New York

“… 10 In Boston, of 2183 individuals screened who had lived in Latin America for at least 6 months, 19 (0.9%) were confirmed positive. 5 …”

“…We sought to perform a Chagas disease seroprevalence study and risk factor assessment among Latin American children living in Suffolk County, New York. We are aware of only one other seroprevalence study in the United States that enrolled children, 5 underscoring the tremendous gap in knowledge of pediatric Chagas disease in the US.…”