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A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform.

Abstract Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem.
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Authors

Mayor MeshTerms
Keywords
Journal Title plos neglected tropical diseases
Publication Year Start




PMID- 28820896
OWN - NLM
STAT- Publisher
DA  - 20170818
LR  - 20170818
IS  - 1935-2735 (Electronic)
IS  - 1935-2727 (Linking)
VI  - 11
IP  - 8
DP  - 2017 Aug 18
TI  - A strategy for scaling up access to comprehensive care in adults with Chagas
      disease in endemic countries: The Bolivian Chagas Platform.
PG  - e0005770
LID - 10.1371/journal.pntd.0005770 [doi]
AB  - BACKGROUND: Bolivia has the highest prevalence of Chagas disease (CD) in the
      world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection,
      most of them adults. In Bolivia CD has been declared a national priority. In
      2009, the Chagas National Program (ChNP) had neither a protocol nor a clear
      directive for diagnosis and treatment of adults. Although programs had been
      implemented for congenital transmission and for acute cases, adults remained
      uncovered. Moreover, health professionals were not aware of treatment
      recommendations aimed at this population, and research on CD was limited; it was 
      difficult to increase awareness of the disease, understand the challenges it
      presented, and adapt strategies to cope with it. Simultaneously, migratory flows 
      that led Bolivian patients with CD to Spain and other European countries forced
      medical staff to look for solutions to an emerging problem. INTERVENTION: In this
      context, thanks to a Spanish international cooperation collaboration, the
      Bolivian platform for the comprehensive care of adults with CD was created in
      2009. Based on the establishment of a vertical care system under the umbrella of 
      ChNP general guidelines, six centres specialized in CD management were
      established in different epidemiological contexts. A common database,
      standardized clinical forms, a and a protocolized attention to adults patients,
      together with training activities for health professionals were essential for the
      model success. With the collaboration and knowledge transfer activities between
      endemic and non-endemic countries, the platform aims to provide care, train
      health professionals, and create the basis for a future expansion to the National
      Health System of a proven model of care for adults with CD. RESULTS: From 2010 to
      2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were
      diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than
      1,616 health professionals were trained, and more than ten research projects
      developed. The project helped to increase the number of adults with CD diagnosed 
      and treated, produce evidence-based clinical practice guidelines, and bring about
      changes in policy that will increase access to comprehensive care among adults
      with CD. The ChNP is now studying the Platform's health care model to adapt and
      implement it nationwide. CONCLUSIONS: This strategy provides a solution to unmet 
      demands in the care of patients with CD, improving access to diagnosis and
      treatment. Further scaling up of diagnosis and treatment will be based on the
      expansion of the model of care to the NHS structures. Its sustainability will be 
      ensured as it will build on existing local resources in Bolivia. Still human
      trained resources are scarce and the high staff turnover in Bolivia is a
      limitation of the model. Nevertheless, in a preliminary two-years-experience of
      scaling up this model, this limitations have been locally solved together with
      the health local authorities.
FAU - Pinazo, Maria-Jesus
AU  - Pinazo MJ
AUID- ORCID: http://orcid.org/0000-0002-4237-1075
AD  - International Health Department, ISGlobal, Barcelona Center for International
      Health Research, (CRESIB), Hospital Clinic-Universitat de Barcelona, Spain.
FAU - Pinto, Jimy
AU  - Pinto J
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Ortiz, Lourdes
AU  - Ortiz L
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Sanchez, Jareth
AU  - Sanchez J
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Garcia, Wilson
AU  - Garcia W
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Saravia, Ruth
AU  - Saravia R
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Cortez, Mirko-R
AU  - Cortez MR
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Moriana, Silvia
AU  - Moriana S
AD  - Chagas Disease Global Coalition, Barcelona, Spain.
FAU - Grau, Enric
AU  - Grau E
AD  - International Health Department, ISGlobal, Barcelona Center for International
      Health Research, (CRESIB), Hospital Clinic-Universitat de Barcelona, Spain.
FAU - Lozano, Daniel
AU  - Lozano D
AD  - Fundacion CEADES, Cochabamba, Bolivia.
FAU - Gascon, Joaquim
AU  - Gascon J
AD  - International Health Department, ISGlobal, Barcelona Center for International
      Health Research, (CRESIB), Hospital Clinic-Universitat de Barcelona, Spain.
FAU - Torrico, Faustino
AU  - Torrico F
AD  - Fundacion CEADES, Cochabamba, Bolivia.
LA  - eng
PT  - Journal Article
DEP - 20170818
PL  - United States
TA  - PLoS Negl Trop Dis
JT  - PLoS neglected tropical diseases
JID - 101291488
EDAT- 2017/08/19 06:00
MHDA- 2017/08/19 06:00
CRDT- 2017/08/19 06:00
PHST- 2016/12/12 [received]
PHST- 2017/07/03 [accepted]
AID - 10.1371/journal.pntd.0005770 [doi]
AID - PNTD-D-16-02207 [pii]
PST - aheadofprint
SO  - PLoS Negl Trop Dis. 2017 Aug 18;11(8):e0005770. doi:
      10.1371/journal.pntd.0005770.