Chagas disease, a parasitic disease commonly found in Latin America, has become a global public health concern. Affecting more than six million people annually, Chagas is one of 17 illnesses acknowledged as neglected tropical diseases. Also known as American trypanosomiasis, Chagas is primarily transmitted to humans through the feces of triatomine bugs, also known as “kissing bugs,” when they bite and feed on blood. The disease can also be transmitted through blood transfusions, organ transplantation, contaminated, uncooked food and from mother to child during pregnancy.

Chagas claims more than 12,000 lives each year and is the leading cause of heart disease in the Americas. However, the disease is treatable. While most Chagas patients are infected as children, symptoms often only manifest in adulthood, by which time it is often too late. The majority of cases occur in poor communities in Central and South America, where 99% remain ultimately untreated due to inadequate global Chagas surveillance. Today, Bolivia has the highest worldwide prevalence of Chagas disease.

Bolivia’s Efforts at Disease Control

Although the Bolivian Ministry of Health declared the prevention and treatment of Chagas to be of national interest, lack of resources, management, implementation and regulation of solutions prevented the introduction of treatment until the early 2000s.

In 2009, in conjunction with the CEADES Foundation and the Barcelona Institute for Global Health (ISGlobal), Bolivia established the Platform for the Integral Care of Patients with Chagas Disease. The platform aimed to provide comprehensive care for individuals with chronic infection. It was based on four pillars:

1. providing care
2. training health personnel
3. performing research
4. engaging with the community

The Bolivian Chagas Platform developed a two-stage plan aimed at addressing the situation. First, the platform implemented a top-down test program to introduce a health care plan using protocols to work closely with local health authorities in seven local centers. From 2009 to 2014, the program was recognized as a successful approach for effectively handling Chagas disease in three of Bolivia’s most affected cities.

In the second phase of the Bolivian Chagas platform, starting in 2015, the model was expanded to 52 primary health care centers. This expansion was achieved through a decentralized and horizontally scaled-up approach. At the end of the second phase in 2018, more than 181,000 people at risk for Chagas received testing, resulting in a 32% increase in diagnoses and considerably improved patient care. Additionally, 67% of health care workers in the intervention area received training specific to the Chagas Platform guidelines. Chagas screening has now been implemented for regulatory health care visits.

Current Situation and the Way Forward

Although Bolivia ranks as the leading country in the global prevalence of Chagas, it fell from first to fourth position in terms of the number of people infected by the disease as of 2015, after the program’s first stage. The global impact of Chagas disease has demonstrated a consistent decrease in the number of cases.

While most are still concentrated in Latin America, the rising numbers in North America and Europe underscore the need to screen high-risk populations and increase awareness of this overlooked tropical disease. Chagas persists today as an endemic disease in 21 countries. With adequate resources, quality of diagnosis, proper treatment and primary health care integration, the effects of the Bolivian Chagas Platform can ensure long-term success.

– Bella Simokaitis
Photo: Flickr