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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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.


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
Título revista:PLoS Neglected Tropical Diseases
Título revista abreviado:PLoS. Negl. Trop. Dis.
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


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---------- 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).
---------- 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).
---------- 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.
---------- 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).