Current Gaps and Needs for Increasing Access to Healthcare for People with Chagas Disease in the USA

Abstract

Purpose of Review In the USA, fewer than 1% of people with Chagas disease (CD) are diagnosed and treated. Patients and physicians confront significant barriers to initiating testing and treatment, which are not systematically available in the US health care system. What are these barriers and how can they be overcome? We discuss the broader challenges and state-level dynamics of CD in several of the US states with the highest burdened populations. Recent Findings The principal challenges for expanding access to testing and treatment include confusion surrounding testing procedures, limitations in available drugs and diagnostic tools, gaps in surveillance and epidemiological knowledge, low patient awareness, and, particularly, low awareness among providers. States have key differences concerning health care access, transmission dynamics, and programmatic resources. Local initiatives in Texas and California are discussed. Summary Reducing the burden of CD will require improvement of diagnostic capacity and treatment guidelines, significant strengthening of provider awareness, greater understanding of transmission dynamics, and provision of accessible health care to the diverse population at risk.

Assessing the Effectiveness of Chagas Disease Education for Healthcare Providers in the United States

“…(5, 9, 10) Although Chagas disease is most commonly found in Latin American countries, there has been a growing concern that it is vastly underestimated in the United States (1-5, 9, 11) Estimates that use modeled data suggest that there are between 326,000 and 347,000 individuals born in Latin America living in the United States that are infected with T.cruzi. (2,3,12) This population may hold the highest burden of Chagas disease in the United States due to a higher prevalence in their countries of origin. (13,14) However, in the southern United States there have been an increasing number of autochthonous and congenital transmission cases being reported since 2000.…”

“…(18,27) Regardless of where a person is infected, less than 1% of people in the United States will ever receive a clinical diagnosis of Chagas disease and even fewer will ever receive treatment. (4,12) This lack of diagnosis and treatment is a result of a combination of factors including an absence of awareness by healthcare providers, limited diagnostic tools, and access to healthcare by the populations most vulnerable to this disease. (12,28,29) According to Lynn, et al, they found that shared risk factors for transmission of Chagas disease in the United States were living in a rural area and/or a history of outdoor activities or work.…”

“…(4,12) This lack of diagnosis and treatment is a result of a combination of factors including an absence of awareness by healthcare providers, limited diagnostic tools, and access to healthcare by the populations most vulnerable to this disease. (12,28,29) According to Lynn, et al, they found that shared risk factors for transmission of Chagas disease in the United States were living in a rural area and/or a history of outdoor activities or work. (15) This leads us to conclude that healthcare providers serving populations in rural areas or underserved migrant population are a good starting point to target Chagas disease education efforts.…”

“…(15) This leads us to conclude that healthcare providers serving populations in rural areas or underserved migrant population are a good starting point to target Chagas disease education efforts. (12,(29)(30)(31) As of 2017, only six states participate in surveillance and reporting of Chagas disease. (12,31,32) Educational materials on Chagas disease may be found online by several different sources and from the individual state health departments and the Centers for Disease Control and Prevention (CDC).…”

“…(12,(29)(30)(31) As of 2017, only six states participate in surveillance and reporting of Chagas disease. (12,31,32) Educational materials on Chagas disease may be found online by several different sources and from the individual state health departments and the Centers for Disease Control and Prevention (CDC). Despite the availability of educational materials, a study on patient perspectives and access to Chagas disease in the United States emphasizes low awareness among providers and nonexistent health education campaigns as barriers to treatment.…”