A four-step process for building sustainable access to diagnosis and treatment of Chagas disease

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.

WHF IASC Roadmap on Chagas Disease

“…The Platform demonstrates the possibility of dramatically scaling up access and provides a robust model for national adoption in Bolivia. The 4D (Diagnose, Design, Deliver, Demonstrate) approach utilized in Colombia provides another example of a multi-stakeholder pilot project which delivers a comprehensive model of care [131]. This model is also based on a collaborative approach with government and stakeholders, and aims to deliver a model of care which is needs based and data driven, with associated health care system and health care worker capacity building to ensure sustainability of the project.…”

“Chagas Express XXI”: A new ArtScience social technology for health and science education—A case study in Brazilian endemic areas of Chagas disease with an active search of chronic cases

“…Discoveries continuously feed the scientific literature but only when translated into products, processes, and tools they can turn into innovations, causing an impact of various nature in the social context; adding either tangible or intangible value [19,24]. All CE21 activities were founded in the 13 thinking tools / cognitive categories, described by Robert and Michèle Root-Bernstein [28], and intensively used in our ArtScience education workshops [19,24], as to know: (1) Observing and registering, not simply watching, to go beyond the visual aspect of seeing; (2) Imaging, evoking images, creating visual representations in the mind; (3) Abstracting to take something and to simplify it to its most important single element, to imagine what something could be that it is not really is; (4) Recognizing patterns, identifying what is common and what is unique; (5) Forming patterns, creating something different by combining two or more elements together; (6) Making analogies, finding a relationship in size, function, form, or other; (7) Thinking with the whole body, moving the body through space to let imagination flow; (8) Empathizing, putting oneself in someone else's position, changing the perspective and the point of view; (9) Thinking in a dimensional way, moving from 2D to 3D, 4D (including time, movement and sensorial inputs), or 5D (including symbolic representations), scaling, or altering the proportions and symbols; (10) Modeling, creating representation of something in a physical (and even functional) form; (11) Playing, simply for the fun and for the joy of doing something; (12) Transforming, altering some thing or some tool into another thing or another tool; (13) Synthesizing, describing a complex and whole idea in few words, in a picture, or in a movement or sound. These categories are important to promote and to consolidate creativity [24][25][26].…”

“…The infection persists for an asymptomatic chronic indeterminate period that can last a lifetime in most people. During this time, about 70% of the infected people are unaware of the infection and it is estimated that only 10% of cases are adequately diagnosed by laboratory tests and that less than 1% are properly and timely treated with available trypanosomicide drugs [7]. The remaining, about 30% of chronically T. cruzi-infected persons, evolve with relevant health problems such as cardiopathy that may progress to heart failure and digestive complications [8].…”

“…Despite the amount of biomedical information on CD [ 2 , 6 ], it is mostly invisible to society and education is an issue stressed as necessary since the centennial of CD discovery [ 12 ]. People from endemic areas are generally not aware about the risks related to transmission nor about the implication of taking the proper medicine as soon as they are diagnosed [ 7 , 13 , 14 ]. The social debt with CD affected people needs to be redeemed with a robust partnership between public entities and the organized civil society.…”

“…This is what the “Chagas Express XXI” (CE21) is expected to bring to the endemic areas where CD vectors are still a risk for T . cruzi transmission and deserve continuous environmental and health surveillance where both health professionals and citizens are not well informed, communicated nor educated concerning threats related to both the acute and chronic CD [ 6 , 7 , 13 ].…”