Abstract
BackgroundRural populations in the Gran Chaco region have large prevalence rates of Trypanosoma cruzi infection and very limited access to diagnosis and treatment. We implemented an innovative strategy to bridge these gaps in 13 rural villages of Pampa del Indio held under sustained vector surveillance and control.MethodologyThe non-randomized treatment program included participatory workshops, capacity strengthening of local health personnel, serodiagnosis, qualitative and quantitative PCRs, a 60-day treatment course with benznidazole and follow-up. Parents and healthcare agents were instructed on drug administration and early detection and notification of adverse drug-related reactions (ADR). Healthcare agents monitored medication adherence and ADRs at village level.Principal findingsThe seroprevalence of T. cruzi infection was 24.1% among 395 residents up to 18 years of age examined. Serodiagnostic (70%) and treatment coverage (82%) largely exceeded local historical levels. Sixty-six (85%) of 78 eligible patients completed treatment with 97% medication adherence. ADRs occurred in 32% of patients, but most were mild and manageable. Four patients showing severe or moderate ADRs required treatment withdrawal. T. cruzi DNA was detected by qPCR in 47 (76%) patients before treatment, and persistently occurred in only one patient over 20–180 days posttreatment.Conclusions and significanceOur results demonstrate that diagnosis and treatment of T. cruzi infection in remote, impoverished rural areas can be effectively addressed through strengthened primary healthcare attention and broad social participation with adequate external support. This strategy secured high treatment coverage and adherence; effectively managed ADRs, and provided early evidence of positive therapeutic responses.
Highlights
Chagas disease ranks among the main neglected tropical diseases (NTDs) in Latin America and the Caribbean [1]
Our results demonstrate that diagnosis and treatment of T. cruzi infection in remote, impoverished rural areas can be effectively addressed through strengthened primary healthcare attention and broad social participation with adequate external support
Our results show that diagnosis and treatment of T. cruzi infection there can be effectively addressed through strengthened primary healthcare attention and broad social participation with adequate external support, following an initial phase of intensified vector control and surveillance across the municipality
Summary
Chagas disease ranks among the main neglected tropical diseases (NTDs) in Latin America and the Caribbean [1]. The two drugs (nifurtimox and benznidazole) registered for treatment of human infection with T. cruzi since the late 1960s and early 1970s were shown to be especially effective in young age groups during the acute and early chronic phase regardless of transmission mode [3,13,14,15,16,17,18]. Both nifurtimox and benznidazole cause adverse drug-related reactions (ADR) of various types, frequency and severity which increase with increasing patient’s age and reduce treatment compliance and effectiveness [19,20,21,22]. We implemented an innovative strategy to bridge these gaps in 13 rural villages of Pampa del Indio held under sustained vector surveillance and control
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