How to implement the framework for the elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas (EMTCT Plus) in a disperse rural population from the Gran Chaco region: A tailor-made program focused on pregnant women

Crudo, Favio; Piorno, Pablo; Krupitzki, Hugo; Guilera, Analia; López-Albizu, Constanza; Danesi, Emmaría; Scollo, Karerina; Lloveras, Susana; Mir, Sebastián Nelson Rivera; Alvarez, Marisa Viviana; Yudis, Silvio; Fernández, Miguel Angel Cayo; Cipri, Diego; Krolewiecki, Alejandro; Pereiro, Ana Cristina; Periago, María Victoria; Abril, Marcelo; Fernández, Mariana

doi:10.1371/journal.pntd.0008078

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…This new scenario demands the availability of RDTs of acceptable evaluated performance, as demonstrated by the SD and WL tests. Currently, an implementation of EMTCT-Plus is being carried out in the Gran Chaco region (Argentina, Bolivia, and Paraguay), using the SD and WL RDTs for Chagas detection in pregnant women, as well as RDTs for HIV, syphilis, and hepatitis B ( 43 ).…”

Section: Discussionmentioning

confidence: 99%

Rapid Diagnostic Tests for Trypanosoma cruzi Infection: Field Evaluation of Two Registered Kits in a Region of Endemicity and a Region of Nonendemicity in Argentina

et al. 2020

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Infection by Trypanosoma cruzi or Chagas Disease (ChD) affects around 7 million people in the Americas, most of which are unaware of their status due to lack of clinical manifestations and poor access to diagnosis. Rapid diagnostic tests (RDTs) are widely used for screening different infections (HIV, Hepatitis B, Syphilis), and their application for ChD would facilitate access to diagnosis, especially in remote areas where health services have scarce resources. We conducted a prospective intervention study during 2018 to evaluate in field two RDTs for ChD, authorized by the National Administration of Medicaments, Aliments, and Medical Technologies of Argentina (ANMAT), to in vitro diagnostic reactive; in endemic and non-endemic areas of Argentina. We recruited 607 volunteers older than 18 years in Salta province and City of Buenos Aires. The RDTs Ab Standard Diagnostics SD Bioline® (SD) and Check Chagas Wiener Lab® (WL) were performed in situ with whole blood sample, and confirmatory serology was done at a reference center. The rate of infection with T. cruzi was 17.8% (108/607). SD test showed a performance of 97.2% sensitivity (95%CI 93.5-100), 91.7% specificity (95%CI 96.2-99.2%), and WL test 93.4% sensitivity (95%CI 88.2-98.6%), 99.1% specificity (95%CI 91.9-100%). The sensitivity and specificity for the two RDTs tested were higher than previously reported. These results encourage the use of the tested RDTs in Salta province and to perform further field studies for the implementation of these RDTs in other epidemiological scenarios. This will be very important to improve access to diagnosis of Chagas and its clinical manage as a neglected disease, especially in remote areas with health access barriers.

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Section: Discussionmentioning

confidence: 99%

Rapid Diagnostic Tests for Trypanosoma cruzi Infection: Field Evaluation of Two Registered Kits in a Region of Endemicity and a Region of Nonendemicity in Argentina

et al. 2020

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“…Historically, disease control efforts have focused on vector control [ 86 ], leaving health systems unprepared to address cCD [ 87 ]. This historical lack of emphasis on prevention of cCD has been reflected in the poor quality and paucity of research conducted on its prevention prior to major regional disease control programs in Latin America [ 88 ]. In light of this, the body of cCD literature still lacks in quality and further investment is needed.…”

Section: Discussionmentioning

confidence: 99%

Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis

et al. 2022

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Chagas disease is caused by the parasite Trypanosoma cruzi which can be transmitted from mother to baby during pregnancy. There is no consensus on the proportion of infected infants with clinical signs of congenital Chagas disease (cCD). The objective of this systematic review is to determine the burden of cCD. Articles from journal inception to 2020 reporting morbidity and mortality associated with cCD were retrieved from academic search databases. Observational studies, randomized-control trials, and studies of babies diagnosed with cCD were included. Studies were excluded if they were case reports or series, without original data, case-control without cCD incidence estimates, and/or did not report number of participants. Two reviewers screened articles for inclusion. To determine pooled proportion of infants with cCD with clinical signs, individual clinical signs, and case-fatality, random effects meta-analysis was performed. We identified 4,531 records and reviewed 4,301, including 47 articles in the narrative summary and analysis. Twenty-eight percent of cCD infants showed clinical signs (95% confidence interval (CI) = 19.0%, 38.5%) and 2.2% of infants died (95% CI = 1.3%, 3.5%). The proportion of infected infants with hepatosplenomegaly was 12.5%, preterm birth 6.0%, low birth weight 5.8%, anemia 4.9%, and jaundice 4.7%. Although most studies did not include a comparison group of non-infected infants, the proportion of infants with cCD with clinical signs at birth are comparable to those with congenital toxoplasmosis (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). We conclude that cCD burden appears significant, but more studies comparing infected mother-infant dyads to non-infected ones are needed to determine an association of this burden to cCD.

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“…Disease control efforts historically have focused on vector control [85] historically leaving health systems unprepared to address cCD [86]. This is reflected in poor quality of studies published prior to major regional efforts in Latin America and the Caribbean (2017) [87]. The World Heart Federation has identified gaps in efforts to reduce cCD including ill-prepared healthcare personnel and lack of pregnancy screening programs [86].…”

Section: Discussionmentioning

confidence: 99%

Estimation of the morbidity and mortality of congenital Chagas disease: a systematic review and meta-analysis

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Tannis

Puchner

et al. 2022

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Chagas disease is caused by the parasite Trypanosoma cruzi , which can be passed from mother to infant. It is estimated that one million women of reproductive age are infected with T. cruzi. Prior to our work, the proportion of infants infected with T. cruzi congenitally presenting with clinical symptoms was unknown. After systematically searching for and identifying studies that collected information on infants with congenital Chagas disease, we summarized and analyzed 47 studies. Our pooled analysis of these studies estimated that 28.3% of infants with congenital Chagas disease were symptomatic and 2.2% died. Prior work has shown that transmission of T. cruzi from mother to child occurs in 5% of cases. Other studies have shown that this transmission is preventable through treatment of women prior to conception, and infants can be cured if shown to be infected at birth. Our estimated proportion of 28.3% of infants diagnosed with cCD at birth presenting with clinical symptoms are comparable to infants diagnosed with congenital toxoplasmosis presenting with clinical symptoms (10.0%-30.0%) and congenital cytomegalovirus (10.0%-15.0%). More studies comparing infected mother-infant dyads to non-infected mother-infant dyads are needed to determine an association of this burden to cCD infection.

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How to implement the framework for the elimination of mother-to-child transmission of HIV, syphilis, hepatitis B and Chagas (EMTCT Plus) in a disperse rural population from the Gran Chaco region: A tailor-made program focused on pregnant women

Cited by 10 publications

References 9 publications

Rapid Diagnostic Tests for Trypanosoma cruzi Infection: Field Evaluation of Two Registered Kits in a Region of Endemicity and a Region of Nonendemicity in Argentina

Rapid Diagnostic Tests for Trypanosoma cruzi Infection: Field Evaluation of Two Registered Kits in a Region of Endemicity and a Region of Nonendemicity in Argentina

Estimation of the morbidity and mortality of congenital Chagas disease: A systematic review and meta-analysis

Estimation of the morbidity and mortality of congenital Chagas disease: a systematic review and meta-analysis

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