Abstract
ObjectivesChagas disease (CD) represents a growing problem in Europe; Italy is one of the most affected countries but there is no national framework for CD and access-to-care is challenging. In 2012 Médecins Sans Frontières (MSF) started an intervention in Bergamo province, where many people of Latin American origin (PLAO) are resident. A new model-of-care for CD, initiated by Centre for Tropical Diseases of Sacro Cuore Hospital, Negrar (CTD), the NGO OIKOS and the Bolivian community since 2009 in the same area, was endorsed. Hereby, we aim to describe the prevalence of CD and the treatment management outcomes among PLAO screened from 1st June 2012 to 30th June 2013.MethodsRetrospective cohort study using routine program data. Screening sessions were done in Bergamo at OIKOS outpatient service and serological confirmation, staging and treatment for CD was offered at the CTD. MSF provided health education on CD, awareness generation prior to screening days, pre-test and post-test counselling through cultural mediators of Latin American origin.ResultsOf 1305 PLAO screened, 223(17%) had CD. Among 210 patients eligible for treatment, 102(49%) were lost-to-follow-up before treatment. The median delay from diagnosis to treatment was 4 months (range 0.7–16.6 months). Among 108 started on treatment, 63(58%) completed treatment, 36(33%) interrupted treatment, (33 for drug side-effects, two for patients decision and one due to pregnancy), 6(6%) were lost-to-follow-up and 3(3%) were on treatment at study censuring.ConclusionIn this first study focusing on process of care for CD in Italy, less than 30% of patients completed treatment with drop-outs along the cascade of care. There is an urgent need to involve affected communities and local regional health authorities to take part to this model-of-care, adapting it to the local epidemiology. The Italian health authorities should take steps in advocating for a change in the current paradigm.
Highlights
Chagas disease (CD), known as American Trypanosomiasis, is caused by the protozoan parasite Trypanosoma cruzi
The Challenge of Access-to-Care for Chagas Disease in Northern Italy patients decision and one due to pregnancy), 6(6%) were lost-to-follow-up and 3(3%) were on treatment at study censuring. In this first study focusing on process of care for CD in Italy, less than 30% of patients completed treatment with drop-outs along the cascade of care
Our results show that the prevalence of Chagas disease among people of Latin American origin in Bergamo province was high and that, despite an increased access to diagnosis and treatment in the program, many people did not complete the full course of treatment
Summary
Chagas disease (CD), known as American Trypanosomiasis, is caused by the protozoan parasite Trypanosoma cruzi. According to the World Health Organization (WHO) there are about 8 million [1] estimated cases of CD worldwide, and about 11,000 attributed annual global deaths [2]. The disease is mainly transmitted to animals and people through the faeces of insect vectors —the blood sucking triatominae bugs known as the“kissing bugs” [4]. If patient is untreated or inadequately treated, a chronic phase follows during which the infection may remain unnoticed for several decades or even for life. Up to 40% of patients may develop serious, lifethreatening cardiovascular and/or gastrointestinal or neurological complications that may even result in sudden death [5]. Given the difficulty in predicting who will develop complications, all diagnosed individuals should be offered treatment in order to reduce disease transmission risk [6] and evolution [7]. Only 1% of the globally infected population have access to diagnosis and treatment (a 99% access gap)[5, 8, 28]
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