Sociocultural dynamics that influence Chagas disease health care in Colombia

Martinez-Parra, Adriana Gisela; Pinilla-Alfonso, María Yaneth; Abadía‐Barrero, César Ernesto

doi:10.1016/j.socscimed.2018.09.012

Cited by 25 publications

(18 citation statements)

References 38 publications

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“…The central idea is that, if members of the public understand what CD is and how it is transmitted, this knowledge will reduce infection rates [51]. In addition to community members, these educational interventions can include professional home inspectors [52] and physicians [53,54]. Although the causal mechanism is rarely explained, researchers argue that, if individuals become more aware of the severity of CD and their susceptibility to the disease, they will be more likely to seek preventive measures [55][56][57].…”

Section: Discussionmentioning

confidence: 99%

Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador

et al. 2020

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Introduction Control of triatomine infestation is a key strategy for the prevention of Chagas disease (CD). To promote this strategy, it is important to know which antecedents to behavioral change are the best to emphasize when promoting prevention. Objective The aim of this study was to determine predictors for intention to prevent home infestation based on the Health Belief Model (HBM), a commonly used health intervention planning theory. Materials & methods A cross-sectional study was conducted with 112 heads of household in six communities with endemic and high rates of triatomine infestation in Loja province, Ecuador. The data was collected by a questionnaire including perceived severity, susceptibility, benefits to action, barriers to action, and self-efficacy. These data were also used to predict actual infestation of homes. Results Community members reported strong intentions to prevent home infestation. HBM constructs predicted about 14% of the observed variance in intentions. Perceived susceptibility and severity did not predict behavioral intention well; perceived barriers to small-scale action that reduce likelihood of infestation and self-efficacy in participating in surveillance systems

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Section: Discussionmentioning

confidence: 99%

Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador

et al. 2020

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“…Despite this progress, the number of CD patients receiving treatment remains low (45). This deficiency stems from various interrelated barriers, including the low priority given to CD by public health systems; the political marginalization and economic insecurity of the affected population (9, 11); low awareness among laypeople and physicians (13, 46, 47); diagnostic challenges (48); stigmatization and fear surrounding CD (12, 49); the lack of a test of cure (8); and the absence of treatment options in or near patients’ communities (10, 13). These barriers inhibit the demand for diagnostic and therapeutic products; in turn, low demand does not sustain production levels necessary for reaching millions of untreated individuals with CD.…”

Section: Dndi and Access To Chagas Disease Treatmentmentioning

confidence: 99%

“…Studies in Mexico, the United States, and Colombia indicate that fewer than 1% of people with CD have access to diagnosis and treatment (5 – 7). Diverse barriers perpetuate this neglect, including clinical challenges associated with diagnosing and treating CD (8), political and socioeconomic inequalities (9 – 12), and gaps in health care systems (5 – 7, 13). Moreover, the epidemiologic profile of CD has presented new challenges.…”

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confidence: 99%

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

Batista

Forsyth

Herazo

et al. 2019

Revista Panamericana De Salud Pública

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The vast majority of people with Chagas disease (CD) are undiagnosed and untreated. Improving access to diagnosis and treatment for CD involves confronting a wide range of barriers. This report discusses a collaborative approach to eliminate barriers and increase the availability of CD testing and treatment. Potential areas for intervention are selected based on burden of disease, support of local champions, and commitment from national and local authorities. A 4D approach (diagnose, design, deliver, and demonstrate impact) is then implemented. The diagnose step involves gathering key stakeholders at a seminar to collaboratively identify important barriers and propose solutions. The design step creates a specific plan to act upon the seminar’s conclusions with consensus on core indicators. The deliver step entails implementing the plan at pilot locations, while simultaneously strengthening health system capacity for CD testing and treatment. Lastly, the demonstrate impact step compares baseline data with annual post-implementation data to measure progress. In Colombia, this approach has helped simplify testing procedures and increase CD testing and treatment access in pilot communities, though challenges remain. The 4D approach represents one of several pathways toward ensuring that the best therapeutic and diagnostic products reach people affected by neglected tropical diseases.

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“…Samples from rural areas where most CD patients live were sent to the LNR in Bogotá or reference laboratories in other cities for confirmation (Martinez-Parra et al, 2018). Patients incurred high out-of-pocket expenses for the IFA (often not covered by insurers), plus travel to distant cities where the IFA was available.…”

Section: Introductionmentioning

confidence: 99%

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

Díaz¹,

Forsyth²,

Bernal³

et al. 2019

International Journal of Infectious Diseases

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Chagas disease affects over six million people, but less than 1% are diagnosed and treated. Complicated diagnostic processes are a major barrier. Colombia's previous diagnostic algorithm, using inhouse tests, was difficult to scale up, creating significant access barriers for patients. A new algorithm using commercially manufactured immunoassays would potentially improve access, but these tests' performance in Colombian patients with Chagas disease is not well known. Methods: We assessed seven commercially available assays. Samples (n = 501), 93.8% originating from Colombia, were characterized as positive or negative based on standard procedure at the National Reference Laboratory. Performance characteristics were calculated for individual assays and hypothetical test pairings, then compared to the existing algorithm. Results: Five of seven assays exhibited sensitivity >98% while six showed specificity >97%. A total antigen ELISA paired with a recombinant assay provided similar performance to the current diagnostic process. Six of six assays tested proved capable of detecting different Trypanosoma cruzi genetic lineages. Conclusions: The study indicated that several commercial assays accurately detect T. cruzi infection in Colombian patients. A simplified testing process with two commercial assays could perform comparably to the previous process, reducing cost and accessibility barriers and facilitating national scale-up.

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Sociocultural dynamics that influence Chagas disease health care in Colombia

Cited by 25 publications

References 38 publications

Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador

Determinants of intentions to prevent triatomine infestation based on the health belief model: An application in rural southern Ecuador

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

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

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