Results and evaluation of the expansion of a model of comprehensive care for Chagas disease within the National Health System: The Bolivian Chagas network

Abstract

Background Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world. Methods With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program. Results The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area). Conclusions After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries.

Evaluación del cambio del algoritmo de diagnóstico serológico para la enfermedad de Chagas en Colombia

“…El nuevo algoritmo superó algunas barreras técnicas y operativas, como la dificultad de la disponibilidad de los equipos y reactivos para realizar la segunda prueba, con esta modificación, se pueden procesar las dos pruebas con el mismo equipamiento y con la misma calidad que las pruebas de configuración local del Laboratorio Nacional de Referencia, fortaleciendo la vigilancia por laboratorio (tamizajes colectivos, investigaciones de brotes y búsqueda activa de casos) y el control de calidad. Resultados similares pueden ser observados en la expansión del modelo de atención de Chagas en Bolivia, donde la mejora del algoritmo diagnóstico aporta al aumento de la cobertura en la atención integral de pacientes con la enfermedad de Chagas ( 21 ).…”

Human Pesticide Exposure in Bolivia: A Scoping Review of Current Knowledge, Future Challenges and Research Needs

“…In Bolivia, Chagas disease remains a major public health risk [ 59 ]. Chagas is caused by the parasite Trypanosoma cruzi and is transmitted by triatomine bugs and may cause congestive heart failure if left untreated.…”

Trypanocidal Treatment in Chronic Chagas Disease: Critical Evaluation of Cure Criteria

“…17 Additionally, the optimal management of concurrent comorbidities and comprehensive care contributes to a more favorable therapeutic response following trypanocidal treatment. 18 Within the framework of monitoring cure, various biomarkers have been investigated in CD to evaluate the short-term therapeutic response. 19 However, only a limited number of these biomarkers can reliably determine treatment effectiveness.…”