Artículo

Sartor, P.; Colaianni, I.; Cardinal, M.V.; Bua, J.; Freilij, H.; Gürtler, R.E."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" (2017) PLoS Neglected Tropical Diseases. 11(2)
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Abstract:

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.

Registro:

Documento: Artículo
Título: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
Autor:Sartor, P.; Colaianni, I.; Cardinal, M.V.; Bua, J.; Freilij, H.; Gürtler, R.E.
Filiación:Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de EcologíaGenética y Evolución de Buenos Aires (IEGEBA), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina
Dirección de Epidemiología, Ministerio de Salud de la Provincia del Chaco, Chaco, Argentina
Programa Nacional de Chagas, Ministerio de Salud de la Nación, Buenos Aires, Argentina
Hospital Santojanni, Buenos Aires, Argentina
Instituto Nacional de Parasitología Dr. M. Fatala Chaben, ANLIS C.G. Malbrán, Buenos Aires, Argentina
Palabras clave: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
Año:2017
Volumen:11
Número:2
DOI: http://dx.doi.org/10.1371/journal.pntd.0005336
Handle:http://hdl.handle.net/20.500.12110/paper_19352727_v11_n2_p_Sartor
Título revista:PLoS Neglected Tropical Diseases
Título revista abreviado:PLoS. Negl. Trop. Dis.
ISSN:19352727
CAS:alanine aminotransferase, 9000-86-6, 9014-30-6; alkaline phosphatase, 9001-78-9; aspartate aminotransferase, 9000-97-9; benznidazole, 22994-85-0; cholesterol, 57-88-5; creatinine, 19230-81-0, 60-27-5; ibuprofen, 15687-27-1, 79261-49-7, 31121-93-4, 527688-20-6; paracetamol, 103-90-2; Trypanocidal Agents
Registro:https://bibliotecadigital.exactas.uba.ar/collection/paper/document/paper_19352727_v11_n2_p_Sartor

Referencias:

  • Hotez, P.J., Alvarado, M., Basañez, M.G., Bolliger, I., Bourne, R., The global burden of disease study 2010: interpretation and implications for the neglected tropical diseases (2014) PLoS Negl Trop Dis, 8, p. e2865. , 10.1371/journal.pntd.0002865, 5058013
  • Rassi, A., Jr., Rassi, A., Marin-Neto, J.A., Chagas disease (2010) Lancet, 375, pp. 1388-1402. , 10.1016/S0140-6736(10)60061-X, 0399979
  • Lescure, F.X., Le Loup, G., Freilij, H., Develoux, M., Paris, L., Brutus, L., Pialoux, G., Chagas disease: changes in knowledge and management (2010) Lancet Infect Dis, 10, pp. 556-570. , 10.1016/S1473-3099(10)70098-0, 0670903
  • Hotez, P.J., Ten global "hotspots" for the neglected tropical diseases (2014) PLoS Negl Trop Dis, 8, p. e2496. , 10.1371/journal.pntd.0002496, 4873825
  • Gürtler, R.E., Sustainability of vector control strategies in the Gran Chaco Region: current challenges and possible approaches (2009) Mem Inst Oswaldo Cruz, 104, pp. 52-59. , 9753458
  • Gürtler, R.E., Cecere, M.C., Lauricella, M.A., Petersen, R.M., Chuit, R., Incidence of Trypanosoma cruzi infection among children following domestic reinfestation after insecticide spraying in rural northwestern Argentina (2005) Am J Trop Med Hyg, 73, pp. 95-103. , 6014842
  • Diosque, P., Padilla, A.M., Cimino, R.O., Cardozo, R.M., Negrette, O.S., Chagas disease in rural areas of Chaco Province, Argentina: epidemiologic survey in humans, reservoirs, and vectors (2004) Am J Trop Med Hyg, 71, pp. 590-593. , 5569789
  • Chippaux, J.P., Postigo, J.R., Santalla, J.A., Schneider, D., Brutus, L., Epidemiological evaluation of Chagas disease in a rural area of southern Bolivia (2008) Trans R Soc Trop Med Hyg, 102, pp. 578-584. , 10.1016/j.trstmh.2008.03.008, 8430443
  • Moretti, E., Castro, I., Franceschi, C., Basso, B., Chagas disease: serological and electrocardiographic studies in Wichi and Creole communities of Misión Nueva Pompeya, Chaco, Argentina (2010) Mem Inst Oswaldo Cruz, 105, pp. 621-627. , 0835607
  • Samuels, A.M., Clark, E.H., Galdos-Cardenas, G., Wiegand, R.E., Ferrufino, L., Epidemiology of and impact of insecticide spraying on Chagas disease in communities in the Bolivian Chaco (2013) PLoS Negl Trop Dis, 7, p. e2358. , 10.1371/journal.pntd.0002358, 3936581
  • Lucero, R.H., Brusés, B.L., Cura, C.I., Formichelli, L.B., Juiz, N., Chagas' disease in Aboriginal and Creole communities from the Gran Chaco Region of Argentina: Seroprevalence and molecular parasitological characterization (2016) Infect Genet Evol, 41, pp. 84-92. , 10.1016/j.meegid.2016.03.028, 7057620
  • Rumi, M.M., Pérez Brandán, C., Gil, J.F., D'Amato, A.M., Ragone, P.G., Benznidazole treatment in chronic children infected with Trypanosoma cruzi: serological and molecular follow-up of patients and identification of Discrete Typing Units (2013) Acta Trop, 128, pp. 130-136. , 10.1016/j.actatropica.2013.07.003, 3880286
  • Molina, I., Gómez i Prat, J., Salvador, F., Treviño, B., Sulleiro, E., Randomized trial of posaconazole and benznidazole for chronic Chagas’ disease (2014) N Engl J Med, 370, pp. 1899-1908. , http://dx.doi.org/10.1056/NEJMoa1313122, 4827034
  • de Andrade, A.L., Zicker, F., de Oliveira, R.M., Almeida Silva, S., Luquetti, A., Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection (1996) Lancet, 348, pp. 1407-1413. , 937280
  • de Andrade, A.L., Martelli, C.M., Oliveira, R.M., Silva, S.A., Aires, A.I., Short report: benznidazole efficacy among Trypanosoma cruzi-infected adolescents after a six-year follow-up (2004) Am J Trop Med Hyg, 71, pp. 594-597. , 5569790
  • Sosa Estani, S., Segura, E.L., Ruiz, A.M., Velazquez, E., Porcel, B.M., Efficacy of chemotherapy with benznidazole in children in the indeterminate phase of Chagas' disease (1998) Am J Trop Med Hyg, 59, pp. 526-529. , 790423
  • Flores-Chavez, M., Bosseno, M.F., Bastrenta, B., Dalenz, J.L., Hontebeyrie, M., Polymerase chain reaction detection and serologic follow-up after treatment with benznidazole in Bolivian children infected with a natural mixture of Trypanosoma cruzi I and II (2006) Am J Trop Med Hyg, 75, pp. 497-501. , 6968928
  • Bianchi, F., Cucunubá, Z., Guhl, F., González, N.L., Freilij, H., Follow-up of an asymptomatic Chagas disease population of children after treatment with nifurtimox (Lampit) in a sylvatic endemic transmission area of Colombia (2015) PLoS Negl Trop Dis, 9, p. e0003465. , 10.1371/journal.pntd.0003465, 5723465
  • Altcheh, J., Moscatelli, G., Moroni, S., Garcia-Bournissen, F., Freilij, H., Adverse events after the use of benznidazole in infants and children with Chagas disease (2011) Pediatrics, 127, pp. 212-218
  • Altcheh, J., Moscatelli, G., Mastrantonio, G., Moroni, S., Giglio, N., Population pharmacokinetic study of benznidazole in pediatric Chagas disease suggests efficacy despite lower plasma concentrations than in adults (2014) PLoS Negl Trop Dis, 8, p. e2907. , 10.1371/journal.pntd.0002907, 4853169
  • Yun, O., Lima, M.A., Ellman, T., Chambi, W., Castillo, S., Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Médecins Sans Frontières (2009) PLoS Negl Trop Dis, 3, p. e488. , 10.1371/journal.pntd.0000488, 9582142
  • Tornheim, J.A., Lozano Beltran, D.F., Gilman, R.H., Castellon, M., Solano Mercado, M.A., Improved completion rates and characterization of drug reactions with an intensive Chagas disease treatment program in rural Bolivia (2013) PLoS Negl Trop Dis, 7, p. e2407. , 10.1371/journal.pntd.0002407, 4069472
  • Viotti, R., Vigliano, C., Lococo, B., Alvarez, M.G., Petti, M., Side effects of benznidazole as treatment in chronic Chagas disease: fears and realities (2009) Expert Rev Anti Infect Ther, 7, pp. 157-163. , 10.1586/14787210.7.2.157, 9254164
  • Ribeiro, I., Sevcsik, A.M., Alves, F., Diap, G., Don, R., New, improved treatments for Chagas disease: From the R&D pipeline to the patients (2009) PLoS Negl Trop Dis, 3, p. e484. , 10.1371/journal.pntd.0000484, 9582163
  • Peccoul, B., Batista, C., Stobbaerts, E., Ribeiro, I., Vilasanjuan, R., Gascon, J., The BENEFIT trial: Where do we go from here? (2016) PLoS Negl Trop Dis, 10, p. e0004343. , 10.1371/journal.pntd.0004343, 6913759
  • Viotti, R., Alarcón de Noya, B., Araujo-Jorge, T., Grijalva, M.J., Towards a paradigm shift in the treatment of chronic Chagas disease (2014) Antimicrob Agents Chemother, 58, pp. 635-639. , 10.1128/AAC.01662-13, 4247135
  • Manne, J.M., Snively, C.S., Ramsey, J.M., Salgado, M.O., Bärnighausen, T., Barriers to treatment access for Chagas disease in Mexico (2013) PLoS Negl Trop Dis, 7, p. e2488. , 10.1371/journal.pntd.0002488, 4147169
  • Ventura-Garcia, L., Roura, M., Pell, C., Posada, E., Gascón, J., Socio-cultural aspects of Chagas disease: A systematic review of qualitative research (2013) PLoS Negl Trop Dis, 7, p. e2410. , 10.1371/journal.pntd.0002410, 4069473
  • Dell’Arciprete, A., Braunstein, J., Touris, C., Dinardi, G., Llovet, I., Cultural barriers to effective communication between indigenous communities and health care providers in northern Argentina: an anthropological contribution to Chagas disease prevention and control (2014) Int J Equity Health, 13, p. 6. , 10.1186/1475-9276-13-6, 4476151
  • Declaration of Alma Ata (1978) Declaration of Alma Ata. International Conference on Primary Health Care
  • Neglected Tropical Diseases (2007) Innovative and intensified disease management, WHO/CDS/NTD/IDM/2007.2 World Health Organization
  • Kenny, A., Farmer, J., Dickson-Swift, V., Hyett, N., Community participation for rural health: a review of challenges (2015) Health Expect, 18, pp. 1906-1917. , 10.1111/hex.12314, 5470231
  • McCoy, D., Hall, J., Ridge, M., A systematic review of the literature for evidence on health facility committees in low- and middle-income countries (2012) Health Policy Plan, 27, pp. 449-466. , 10.1093/heapol/czr077, 2155589
  • Laverack, G., Improving health outcomes through community empowerment: a review of the literature (2006) Health Popul Nutr, 24, pp. 113-120
  • Abad-Franch, F., Vega, M.C., Rolón, M.S., Santos, W.S., Rojas de Arias, A., Community participation in Chagas disease vector surveillance: systematic review (2011) PLoS Negl Trop Dis, 5, p. e1207. , 10.1371/journal.pntd.0001207, 1713022
  • Gürtler, R.E., Yadon, Z.E., Eco-bio-social research on community-based approaches for Chagas disease vector control in Latin America (2015) Trans R Soc Trop Med Hyg, 109, pp. 91-98. , 10.1093/trstmh/tru203, 5604759
  • Das, J.K., Salam, R.A., Arshad, A., Maredia, H., Bhutta, Z.A., Community based interventions for the prevention and control of Non-Helmintic NTD (2014) Infect Dis Poverty, 3, p. 24. , 10.1186/2049-9957-3-24, 5114794
  • Sommerfeld, J., Kroeger, A., Innovative community-based vector control interventions for improved dengue and Chagas disease prevention in Latin America: introduction to the special issue (2015) Trans R Soc Trop Med Hyg, 109, pp. 85-88. , 10.1093/trstmh/tru176, 5604757
  • Gürtler, R.E., Kitron, U., Cecere, M.C., Segura, E.L., Cohen, J.E., Sustainable vector control and management of Chagas disease in the Gran Chaco, Argentina (2007) Proc Natl Acad Sci U S A, 104, pp. 16194-16199. , 10.1073/pnas.0700863104, 7913895
  • Gurevitz, J.M., Gaspe, M.S., Enriquez, G.F., Provecho, Y.M., Kitron, U., Intensified surveillance and insecticide-based control of the Chagas disease vector Triatoma infestans in the Argentinean Chaco (2013) PLoS Negl Trop Dis, 7, p. e2158. , 10.1371/journal.pntd.0002158, 3593525
  • Gaspe, M.S., Provecho, Y.M., Cardinal, M.V., Fernández, M.P., Gürtler, R.E., Ecological and sociodemographic determinants of house infestation by Triatoma infestans in indigenous communities of the Argentine Chaco (2014) PLoS Negl Trop Dis, 9, p. e0003614
  • Provecho, Y.M., Gaspe, M.S., del Pilar Fernández, M., Enriquez, G.F., Weinberg, D., Gürtler, R.E., The peri-urban interface and house infestation with Triatoma infestans in the Argentine Chaco: an underreported process? (2014) Mem Inst Oswaldo Cruz, 109, pp. 923-934. , 10.1590/0074-0276140225, 5410997
  • Cardinal, M.V., Orozco, M.M., Enriquez, G.F., Ceballos, L.A., Gaspe, M.S., Heterogeneities in the ecoepidemiology of Trypanosoma cruzi infection in rural communities of the Argentinean Chaco (2014) Am J Trop Med Hyg, 90, pp. 1063-1073. , 10.4269/ajtmh.13-0251, 4732461
  • Schijman, A.G., Altcheh, J., Burgos, J.M., Biancardi, M., Bisio, M., Aetiological treatment of congenital Chagas' disease diagnosed and monitored by the polymerase chain reaction (2003) J Antimicrob Chemother, 52, pp. 441-449. , 10.1093/jac/dkg338, 2917253
  • (2010) Anti-Trypanosoma cruzi Assays: Operational Characteristics
  • Duffy, T., Bisio, M., Altcheh, J., Burgos, J.M., Diez, M., Accurate real-time PCR strategy for monitoring bloodstream parasitic loads in Chagas disease patients (2009) PLoS Negl Trop Dis, 3, p. e419. , 10.1371/journal.pntd.0000419, 9381287
  • Pinazo, M.J., Thomas, M.C., Bua, J., Perrone, A., Schijman, A.G., Biological markers for evaluating therapeutic efficacy in Chagas disease, a systematic review (2014) Expert Rev Anti Infect Ther, 12, pp. 479-496. , 10.1586/14787210.2014.899150, 4621252
  • Murcia, L., Carrilero, B., Muñoz, M.J., Iborra, M.A., Segovia, M., Usefulness of PCR for monitoring benznidazole response in patients with chronic Chagas' disease: a prospective study in a non-disease-endemic country (2010) J Antimicrob Chemother, 65, pp. 1759-1764. , 10.1093/jac/dkq201, 0542903
  • Bua, J., Volta, B.J., Perrone, A.E., Scollo, K., Velázquez, E.B., How to improve the early diagnosis of Trypanosoma cruzi infection: relationship between validated conventional diagnosis and quantitative DNA amplification in congenitally infected children (2013) PLoS Negl Trop Dis, 7, p. e2476. , 10.1371/journal.pntd.0002476, 4147166
  • Corp, S., (2011); Blood-Siegfried, J., Zeantoe, G.C., Evans, L.J., Bondo, J., Forstner, J.R., The impact of nurses on neglected tropical disease management (2015) Public Health Nurs, 32, pp. 680-701. , 10.1111/phn.12149, 5229995
  • O'Malley, G., Asrat, L., Sharma, A., Hamunime, N., Stephanus, Y., Nurse task shifting for antiretroviral treatment services in Namibia: implementation research to move evidence into action (2014) PLoS One, 9, p. e92014. , 10.1371/journal.pone.0092014, 4642894
  • Hernández, C., Cucunubá, Z., Flórez, C., Olivera, M., Valencia, C., Zambrano, P., Molecular diagnosis of Chagas disease in Colombia: Parasitic loads and discrete typing units in patients from acute and chronic phases (2016) PLoS Negl Trop Dis, 10, p. e0004997. , 10.1371/journal.pntd.0004997, 7648938
  • Schijman, A.G., Bisio, M., Orellana, L., Sued, M., Duffy, T., Mejia Jaramillo, A.M., International study to evaluate PCR methods for detection of Trypanosoma cruzi DNA in blood samples from Chagas disease patients (2011) PLoS Negl Trop Dis, 5, p. e931. , 10.1371/journal.pntd.0000931, 1264349
  • Alvarez, M.G., Vigliano, C., Lococo, B., Petti, M., Bertocchi, G., Viotti, R., Seronegative conversion after incomplete benznidazole treatment in chronic Chagas disease (2012) Trans R Soc Trop Med Hyg, 106, pp. 636-638. , 10.1016/j.trstmh.2012.07.010, 2898619
  • Añez, N., Crisante, G., Rojas, A., Araujo, S., Liuzza, A., A follow-up study of chagasic patients with special reference to Trypanosoma cruzi persistence and criteria of Chagas disease cure (2015) Int J Clin Med Res, 2, pp. 20-29
  • George, A.S., Mehra, V., Scott, K., Sriram, V., Community participation in health systems research: A systematic review assessing the state of research, the nature of interventions involved and the features of engagement with communities (2015) PLoS One, 10, p. e0141091. , 10.1371/journal.pone.0141091, 6496124
  • Rifkin, S.B., Examining the links between community participation and health outcomes: a review of the literature (2014) Health Policy Plan, 29, pp. ii98-ii106

Citas:

---------- APA ----------
Sartor, P., Colaianni, I., Cardinal, M.V., Bua, J., Freilij, H. & Gürtler, R.E. (2017) . 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. PLoS Neglected Tropical Diseases, 11(2).
http://dx.doi.org/10.1371/journal.pntd.0005336
---------- CHICAGO ----------
Sartor, P., Colaianni, I., Cardinal, M.V., Bua, J., Freilij, H., Gürtler, R.E. "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" . PLoS Neglected Tropical Diseases 11, no. 2 (2017).
http://dx.doi.org/10.1371/journal.pntd.0005336
---------- MLA ----------
Sartor, P., Colaianni, I., Cardinal, M.V., Bua, J., Freilij, H., Gürtler, R.E. "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" . PLoS Neglected Tropical Diseases, vol. 11, no. 2, 2017.
http://dx.doi.org/10.1371/journal.pntd.0005336
---------- VANCOUVER ----------
Sartor, P., Colaianni, I., Cardinal, M.V., Bua, J., Freilij, H., Gürtler, R.E. 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. PLoS. Negl. Trop. Dis. 2017;11(2).
http://dx.doi.org/10.1371/journal.pntd.0005336