Roadblocks in Chagas disease care in endemic and nonendemic countries: Argentina, Colombia, Spain, and the United States. The NET-Heart project

Abstract

Background Chagas disease (CD) is endemic in Latin America; however, its spread to nontropical areas has raised global interest in this condition. Barriers in access to early diagnosis and treatment of both acute and chronic infection and their complications have led to an increasing disease burden outside of Latin America. Our goal was to identify those barriers and to perform an additional analysis of them based on the Inter American Society of Cardiology (SIAC) and the World Heart Federation (WHF) Chagas Roadmap, at a country level in Argentina, Colombia, Spain, and the United States, which serve as representatives of endemic and nonendemic countries. Methodology and principal findings This is a nonsystematic review of articles published in indexed journals from 1955 to 2021 and of gray literature (local health organizations guidelines, local policies, blogs, and media). We classified barriers to access care as (i) existing difficulties limiting healthcare access; (ii) lack of awareness about CD and its complications; (iii) poor transmission control (vectorial and nonvectorial); (iv) scarce availability of antitrypanosomal drugs; and (v) cultural beliefs and stigma. Region-specific barriers may limit the implementation of roadmaps and require the application of tailored strategies to improve access to appropriate care. Conclusions Multiple barriers negatively impact the prognosis of CD. Identification of these roadblocks both nationally and globally is important to guide development of appropriate policies and public health programs to reduce the global burden of this disease.

Evaluation of the Chagas VirClia® and Chagas TESA VirClia® for the Diagnosis of Trypanosoma cruzi Infection

“…However, it is also important to address the problem in non-endemic areas such as Europe [ 24 ]. Considering the characteristics of endemic and non-endemic countries, different strategies could be implemented to improve the care of CD patients [ 25 ].…”

Direct economic impact of Chagas disease treatment

“…Different barriers prevent appropriate access to diagnosis and treatment and were described for endemic and non-endemic countries. 8 The COVID-19 pandemic has been especially difficult for patients with CD since they are an underdiagnosed risk group, and the negative economic impact of the pandemic particularly affected those with fewer resources, making access to care even more difficult. 9 Leaving aside the medical, psychological, and social benefits, and without performing more complex cost-effectiveness analyses, it seems obvious that diagnosing and treating CD in the acute and chronic phases without demonstrable pathology is profitable.…”

“…Different barriers prevent appropriate access to diagnosis and treatment and were described for endemic and non-endemic countries. 8…”

Impacto de un programa de educación médica virtual para mejorar el diagnóstico de enfermedad de Chagas en Latinoamérica

“…Chagas disease is highly prevalent in Latin America, mainly associated with poverty and adverse socioeconomic conditions 1 . However, recent migratory trends have led to the global dissemination of this disease, generating increasing interest in high-income regions and countries 1 - 4 .…”

“…Chagas disease is highly prevalent in Latin America, mainly associated with poverty and adverse socioeconomic conditions 1 . However, recent migratory trends have led to the global dissemination of this disease, generating increasing interest in high-income regions and countries 1 - 4 . t is estimated that approximately 1 out of every 3 individuals infected with Trypanosoma cruzi will develop cardiac involvement over their lifetime, with a latency period of several decades from the initial infection to the disease 2 , 5 , 6 .…”