Author:
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Pinazo, María Jesús; Pinto, Jimy; Ortiz, Lourdes; Sanchez, Jareth; Garcia, Wilson; Saravia, Ruth; Cortez, Mirko-R.; Moriana, Silvia; Grau, Enric; Lozano, Daniel; Gascón i Brustenga, Joaquim; Torrico, Faustino
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Abstract:
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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. |