Increasing access to comprehensive care for Chagas disease: development of a patient-centered model in Colombia

Abstract

et al. Increasing access to comprehensive care for Chagas disease: development of a patient-centered model in Colombia. Rev Panam Salud Publica. 2017;41:e153. doi: 10.26633/RPSP.2017.153 Worldwide, over 6 million people are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease (CD), yet fewer than 1% of them receive treatment. In Colombia, CD poses a major public health challenge. An estimated 437 000 Colombians are infected with T. cruzi, of whom 131 000 suffer from cardiomyopathy due to the advancement of the disease (1). CD also creates a heavy economic burden; the estimated annual cost of treating a patient in the chronic stage of the disease was US$ 1 028 in 2004 (equivalent to US$ 1 336 in 2017) (2). This entails a total annual cost of US$ 175 016 000 (2017 dollars) for Colombia's health system.CD is most often transmitted by insects of the triatomine subfamily, also known as kissing bugs or, in Colombia, pitos. However, CD can also spread via

Comparative evaluation of immunoassays to improve access to diagnosis for Chagas disease in Colombia

“…Similar simplified diagnostic algorithms have been described in Mexico (INDRE 2019) and Ministry of Health and Sports, Bolivia (2007), while other research indicates that rapid diagnostic tests provide adequate sensitivity and specificity (Sanchez-Camargo et al, 2014). The new algorithm is currently being implemented in a pilot project to eliminate barriers to diagnosis and treatment for people with CD in the departments of Boyacá, Casanare, Santander, and Arauca (Marchiol et al, 2017). It was also employed in 2016-2017 in 23 municipalities to assess levels of seropositivity in children as part of the MSPS's official process of certification of interruption of transmission by Rhodnius prolixus, the main domestic vector.…”

“…The purpose of this study was to (1) validate several immunoassays currently used throughout Colombia's health system, including public health laboratories, private laboratories, and blood banks; (2) determine their sensitivity and specificity and identify the best tests to use for screening and confirmation; and (3) establish a simplified diagnostic algorithm to make CD testing more accessible for Colombian patients. The new diagnostic algorithm would initially be piloted as part of a new, patient-centered roadmap for CD validated by the Ministry of Health and Social Protection (MSPS) in April, 2017 (Marchiol et al, 2017).…”

Clinical and pharmacological profile of benznidazole for treatment of Chagas disease

“…Most importantly, CD predominantly impacts socioeconomically vulnerable groups who face significant challenges in accessing healthcare; these challenges are further magnified for immigrants in Europe and the United States who face legal, social, and linguistic barriers. Incorporation of etiological treatment with BZN and NFX into the primary health care system is still in its infancy, but successful models in Bolivia, Argentina, and elsewhere provide a template other programs can follow [124][125][126].…”

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

“…The access initiative has two primary goals: (i) improve patient access to existing tools, and (ii) pave the way for uptake of new drugs and diagnostics emerging from the R&D pipeline. An access strategy and methodology were developed in consultation with global experts involved in CD, and the first project was implemented in Colombia (50).…”

“…What constitutes success may vary in different contexts. In Colombia, success was defined as creating and widely implementing a new, simplified patient roadmap (50).…”