Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States

Abstract

BackgroundChagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world’s most advanced healthcare systems?Methodology/Principal findingsThis analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma.ConclusionsWe propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.

Asymptomatic Strongyloidiasis among Latin American Migrants in Spain: A Community-Based Approach

“…Most cases that had completed follow-up by the end of the study had been cured of chronic S. stercoralis infection. In that regard, S. stercoralis serology is useful for post-treatment follow-up, as also observed by several research studies in immigrant populations in Europe and North America [ 39 , 44 ].…”

Assessing the effectiveness of Chagas disease education for healthcare providers in the United States

“…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 [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).…”

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

“…(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.…”