ABSTRACT
BACKGROUND: Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world. METHODS: With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program. RESULTS: The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area). CONCLUSIONS: After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries.
Subject(s)
Chagas Disease/diagnosis , Chagas Disease/drug therapy , National Health Programs/organization & administration , Antiparasitic Agents/therapeutic use , Bolivia/epidemiology , Comprehensive Health Care/organization & administration , Health Personnel/education , Health Services Accessibility , Humans , Trypanosoma cruziABSTRACT
Resumen Objetivos: identificar a partir de relatos individuales y familiares los componentes del estigma social asociado a un diagnóstico de Chagas positivo. Métodos: el estudio recopila los testimonios de tres familias a través de entrevistas a profundidad que fueron grabadas, cuyo contenido fue estructurado y luego compartido entre los investigadores a través de un proceso de triangulación. Resultados: se identificaron las diferentes formas de estigma social, experimentado, percibido, anticipado, así como el autoestigma, el estigma por asociación y comportamientos de discriminación; lo que conlleva el aislamiento social, refuerza los miedos tradicionalmente relacionados a esta enfermedad, y provoca tensiones intrafamiliares. El estigma social y el silencio que lo acompaña son serias barreras de acceso a la consulta médica y al tratamiento antiparasitario. Conclusiones: Es importante tomar en cuenta aspectos de tipo psico-socio-cultural en las estrategias de atención integral de Chagas, principalmente en los programas de información, educación, comunicación (IEC) y durante la consulta médica. Para romper el estigma y el silencio que lo acompaña, es indispensable integrar las personas afectadas por Chagas y otros actores de la sociedad civil en el diseño de esas estrategias.
Abstract Objectives: to identify the components of social stigma associated with a positive diagnosis of Chagas disease based on individual and family accounts. Methods: The study compiles the testimonies of 3 families through in-depth interviews that were recorded, the content of which was structured and then shared among the researchers through a process of triangulation. Results: different forms of social stigma, experienced, perceived, anticipated, as well as self-stigma, stigma by association and discriminatory behaviours were identified, leading to social isolation, reinforcing traditional fears associated with the disease, and causing intra-familial tensions. Social stigma and the silence that accompanies it are serious barriers to access to medical consultation and deworming treatment. Conclusions: It is important to take into account psycho-socio-cultural aspects in strategies for comprehensive care of Chagas disease, especially in information, education and communication (IEC) programmes and during the medical consultation. Also, to break the stigma and the silence surrounding it, it's essential to integrate people affected by Chagas and other civil society actors into the conception of these programs.
ABSTRACT
OBJETIVOS: el presente estudio evalúa el cambio en las perspectivas, conocimientos, actitudes y prácticas de los familiares de un grupo de pacientes capacitados con la estrategia de educación por pares que fueron tratados en la Plataforma de atención integral de Chagas, y si ese cambio se traduce en un aumento de la demanda de atención integral de Chagas en los servicios de salud del Valle Alto de Cochabamba. MÉTODOS: se comparó los resultados de la encuesta realizada en 32 familiares de 8 pacientes capacitados en 2018 (grupo A) con una encuesta similar realizada en 64 familiares de 16 pacientes tratados en 2017 (grupo B) que no fueron capacitados, pero en cambio recibieron la consejería que provee el personal de salud de forma rutinaria. RESULTADOS: los resultados obtenidos muestran que los familiares de pacientes educadores pares han modificado sus conocimientos, actitudes, prácticas y percepciones sobre la enfermedad de Chagas y este cambio ha influido positivamente la demanda de atención de servicios integrales para dicha enfermedad. CONCLUSIÓN: la estrategia de educación por pares ha demostrado ser eficaz, fácil de aplicar por un personal de enfermería en los 1º y 2º niveles de atención, y que permite llegar a las familias afectadas a un costo relativamente bajo.(AU)
OBJECTIVES: this study aims to identify changes in the perspectives, knowledges, attitudes and practices of the relatives of a group of patients treated in the Platform of integral care of Chagas, and trained as peer educators, and if that changes led to an increase of the Chagas demand in the health services of Valle Alto, in Cochabamba department. METHODS: we compared the results of the survey conducted on 32 relatives of 8 patients trained in 2018 (group A) with a similar survey conducted on 64 family members of 16 patients treated in 2017 (group B) who were not specifically trained, but received the counseling routinely provided by the health staff. RESULTS: the results show that relatives of peer educators have modified their knowledge, attitudes, practices and perceptions about Chagas disease and this change has influenced the demand for diagnosis of this disease. CONCLUSIONS: the strategy of peer education has proven to be effective, easy to apply by a nursing staff in the 1ª and 2ª levels of care, and allows reaching affected families at an affordable cost.(AU)
