Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation
Background: Rural 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 surveil...
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| Acceso en línea: | https://bibliotecadigital.exactas.uba.ar/collection/paper/document/paper_19352727_v11_n2_p_Sartor http://hdl.handle.net/20.500.12110/paper_19352727_v11_n2_p_Sartor |
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paper:paper_19352727_v11_n2_p_Sartor2023-06-08T16:31:51Z Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation Cardinal, Marta Victoria Búa, Jacqueline Elena Gurtler, Ricardo Esteban alanine aminotransferase alkaline phosphatase antihistaminic agent aspartate aminotransferase benznidazole cholesterol corticosteroid creatinine ibuprofen paracetamol antitrypanosomal agent adolescent adult arthralgia Article Chagas disease child disease transmission dizziness drug dose reduction drug withdrawal enzyme linked immunosorbent assay headache health care access health care personnel human immunofluorescence test infant major clinical study medication compliance myalgia newborn parasite load patient compliance polymerase chain reaction primary health care rash rural area serodiagnosis social participation Argentina Chagas disease health care delivery health service primary health care rural population social participation Argentina Chagas Disease Health Services Accessibility Health Services Administration Humans Primary Health Care Rural Population Social Participation Trypanocidal Agents Background: Rural 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. Methodology: The 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 findings: The 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 significance: 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. This strategy secured high treatment coverage and adherence; effectively managed ADRs, and provided early evidence of positive therapeutic responses. © 2017 Sartor et al. Fil:Cardinal, M.V. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Fil:Bua, J. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Fil:Gürtler, R.E. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. 2017 https://bibliotecadigital.exactas.uba.ar/collection/paper/document/paper_19352727_v11_n2_p_Sartor http://hdl.handle.net/20.500.12110/paper_19352727_v11_n2_p_Sartor |
| institution |
Universidad de Buenos Aires |
| institution_str |
I-28 |
| repository_str |
R-134 |
| collection |
Biblioteca Digital - Facultad de Ciencias Exactas y Naturales (UBA) |
| topic |
alanine aminotransferase alkaline phosphatase antihistaminic agent aspartate aminotransferase benznidazole cholesterol corticosteroid creatinine ibuprofen paracetamol antitrypanosomal agent adolescent adult arthralgia Article Chagas disease child disease transmission dizziness drug dose reduction drug withdrawal enzyme linked immunosorbent assay headache health care access health care personnel human immunofluorescence test infant major clinical study medication compliance myalgia newborn parasite load patient compliance polymerase chain reaction primary health care rash rural area serodiagnosis social participation Argentina Chagas disease health care delivery health service primary health care rural population social participation Argentina Chagas Disease Health Services Accessibility Health Services Administration Humans Primary Health Care Rural Population Social Participation Trypanocidal Agents |
| spellingShingle |
alanine aminotransferase alkaline phosphatase antihistaminic agent aspartate aminotransferase benznidazole cholesterol corticosteroid creatinine ibuprofen paracetamol antitrypanosomal agent adolescent adult arthralgia Article Chagas disease child disease transmission dizziness drug dose reduction drug withdrawal enzyme linked immunosorbent assay headache health care access health care personnel human immunofluorescence test infant major clinical study medication compliance myalgia newborn parasite load patient compliance polymerase chain reaction primary health care rash rural area serodiagnosis social participation Argentina Chagas disease health care delivery health service primary health care rural population social participation Argentina Chagas Disease Health Services Accessibility Health Services Administration Humans Primary Health Care Rural Population Social Participation Trypanocidal Agents Cardinal, Marta Victoria Búa, Jacqueline Elena Gurtler, Ricardo Esteban Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation |
| topic_facet |
alanine aminotransferase alkaline phosphatase antihistaminic agent aspartate aminotransferase benznidazole cholesterol corticosteroid creatinine ibuprofen paracetamol antitrypanosomal agent adolescent adult arthralgia Article Chagas disease child disease transmission dizziness drug dose reduction drug withdrawal enzyme linked immunosorbent assay headache health care access health care personnel human immunofluorescence test infant major clinical study medication compliance myalgia newborn parasite load patient compliance polymerase chain reaction primary health care rash rural area serodiagnosis social participation Argentina Chagas disease health care delivery health service primary health care rural population social participation Argentina Chagas Disease Health Services Accessibility Health Services Administration Humans Primary Health Care Rural Population Social Participation Trypanocidal Agents |
| description |
Background: Rural 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. Methodology: The 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 findings: The 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 significance: 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. This strategy secured high treatment coverage and adherence; effectively managed ADRs, and provided early evidence of positive therapeutic responses. © 2017 Sartor et al. |
| author |
Cardinal, Marta Victoria Búa, Jacqueline Elena Gurtler, Ricardo Esteban |
| author_facet |
Cardinal, Marta Victoria Búa, Jacqueline Elena Gurtler, Ricardo Esteban |
| author_sort |
Cardinal, Marta Victoria |
| title |
Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation |
| title_short |
Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation |
| title_full |
Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation |
| title_fullStr |
Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation |
| title_full_unstemmed |
Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation |
| title_sort |
improving access to chagas disease diagnosis and etiologic treatment in remote rural communities of the argentine chaco through strengthened primary health care and broad social participation |
| publishDate |
2017 |
| url |
https://bibliotecadigital.exactas.uba.ar/collection/paper/document/paper_19352727_v11_n2_p_Sartor http://hdl.handle.net/20.500.12110/paper_19352727_v11_n2_p_Sartor |
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AT cardinalmartavictoria improvingaccesstochagasdiseasediagnosisandetiologictreatmentinremoteruralcommunitiesoftheargentinechacothroughstrengthenedprimaryhealthcareandbroadsocialparticipation AT buajacquelineelena improvingaccesstochagasdiseasediagnosisandetiologictreatmentinremoteruralcommunitiesoftheargentinechacothroughstrengthenedprimaryhealthcareandbroadsocialparticipation AT gurtlerricardoesteban improvingaccesstochagasdiseasediagnosisandetiologictreatmentinremoteruralcommunitiesoftheargentinechacothroughstrengthenedprimaryhealthcareandbroadsocialparticipation |
| _version_ |
1768542665956130816 |