Annex 9 : webinar report

Annex to Final Technical ReportThe report is a brief outline of workshop activities. There were 371 attendees. Chagas is an autochthonous vector, thus control measures must include innovative interventions that require community participation, housing improvement, and articulation of entomological surveillance with epidemiological surveillance. Secondary prevention, that is, caring for people is key to advancing the goal of eliminating chagas disease as a public health problem

Annex 5 : Jutiapa workshop report

Annex to Final Technical Repor

Annex 2 : summary of the main access barriers

Annex of Final Technical ReportThe Alliance project was a joint comprehensive action to contribute to eliminate Chagas disease as a public health problem in Central America and Mexico together with key local partners and actors (See http://hdl.handle.net/10625/59917). This Annex to the project is structured as four Tables: Table 1) Diagnosis: barriers; root causes; solutions Table 2) Treatment and Follow-up: barriers; root causes; solutions Table 3) Surveillance: barriers; root causes; solution Table 4) Elimination of Mother-Child Transmission

Annex 4 : executive summary - Chagas diagnosis

Annex to Final Technical Repor

Project alliances for Chagas diseases elimination in Central America

The report covers activities of the secondary prevention component of the project, which focused on development of a Care Roadmap for people affected by Chagas Disease in the intervention area, while coordinating with primary prevention through institutions in the Alliances project, San Carlos National University (USAC), and Mundo Sano Foundation (FMS). Main results include: identification of barriers to the diagnosis, treatment and comprehensive care of Chagas disease; Support of protocol for the evaluation of the performance of serological diagnostic tests for Chagas disease; Building a comprehensive Chagas Care Roadmap; and Strengthening of local capacity to diagnose and treat the disease

Annex 3 : report barrier seminar

Annex to Final Technical Repor

Treatment and seroconversion in a cohort of children suffering from recent chronic Chagas infection in Yoro, Honduras

Between 1999-2002, Médécins Sans Frontières-Spain implemented a project seeking to determine the efficacy and safety of benznidazole in the treatment of recent chronic Chagas disease in a cohort of seropositive children in the Yoro Department, Honduras. A total of 24,471 children were screened for Trypanosoma cruzi IgG antibodies through conventional enzyme-linked immunosorbent assays (ELISA) on filter paper. Recombinant ELISA (0.93% seroprevalence) showed 256 initially reactive cases, including 232 confirmed positive cases. Of these, 231 individuals were treated with benznidazole (7.5 mg/kg/day) for 60 days and were followed with a strict weekly medical control and follow-up protocol. At the end of the project, 229 patients were examined by the Honduras Secretariat of Health for post-treatment serological assessments; 88.2% seroconverted after 18 months and 93.9% seroconverted after three years. No differences were found in the seroconversion rates according to age or sex. Most of the side effects of the treatment were minor. These results support the argument that in areas where T. cruzi I is predominant and in areas affected by T. cruzi II, when vector transmission has been interrupted, Chagas disease diagnosis and treatment are feasible, necessary and ethically indisputable

Annex 6 : diagnostic evaluation protocol for Chagas disease - Guatemala

Annex to Final Technical Repor

How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis

Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurtimox covered 0.3-0.4% of the infected population. Barriers to accessing screening, diagnosis and treatment are identified for each of the Flagship Framework's five dimensions of interest: financing, payment, regulation, organization and persuasion. The main challenges identified were: a lack of clarity in terms of financial responsibilities in a segmented health system, claims of limited resources for undertaking activities particularly in primary care, non-inclusion of confirmatory test(s) in the basic package of diagnosis and care, poor logistics in the distribution and supply chain of medicines, and lack of awareness of medical personnel. Very low screening coverage emerges as a key obstacle hindering access to care for Chagas disease. Findings suggest serious shortcomings in this health system for Chagas disease, despite the success of universal health insurance scale-up in Colombia. Whether these shortcomings exist in relation to other neglected tropical diseases needs investigating. We identify opportunities for improvement that can inform additional planned health reforms. (C) 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license