DNDi teams and partners continued work to support the decentralization of Chagas diagnosis and treatment in Latin America. In Colombia, support expanded to include projects in a total of seven departments of the country, covering 47 municipalities. The proportion of endemic municipalities implementing the care roadmap for Chagas disease rose to 54% by the end of the year, with 16,484 people tested for Chagas – 11,682 of whom were women of childbearing age.

In Guatemala, DNDi contributed to decentralizing diagnosis and treatment in 3 of 10 endemic areas of the country.

DNDi and partners also continued work to deliver evidence on the use of rapid diagnosis tests (RDTs) to detect T.cruzi infection, with several studies implemented to evaluate RDT performance. In Colombia, a study evaluating the performance of 11 RDTs under laboratory conditions was completed, and a prospective study to evaluate four RDTs under field conditions at five sites is ongoing. In Guatemala, a study was conducted to evaluate the performance of three RDTs under field conditions. In Argentina, DNDi supported the National Institute of Parasitology ‘Dr. Mario Fatala Chaben’ in the validation of commercial RDTs and development of recommendations for their use.

Working with partners, DNDi continued to scale up the test-and-treat approach in Colombia, Guatemala, and Argentina. Major achievements in Guatemala included the consolidation of the healthcare roadmap in Jutiapa, the implementation of the model in Jalapa, capacity strengthening at the local level, and the implementation of a study to evaluate the performance of three rapid tests for use in community settings.

In Colombia, DNDi and partners contributed to the decentralization of diagnosis and treatment in three endemic areas (Cubará, Medina, and Tolima). A study evaluating the performance of 11 rapid tests under laboratory conditions was completed, and a prospective study to evaluate four rapid tests under field conditions at five sites began.

In Argentina, DNDi and partners contributed to the decentralization of diagnosis and treatment in the highly endemic area of Monte Quemado, including the purchase, donation, and installation of equipment, and capacity strengthening activities. These activities were carried out in parallel with the R&D and access components of the redesigned NuestroBen clinical trial, contributing to the recruitment of patients through rapid testing at the local level.

Together with the Colombian Ministry of Health, DNDi has been scaling up the 4D Chagas Access Plan in Colombia, and in Guatemala, DNDi has implemented a decentralized testing and treatment project in the departments of Jutiapa and Jalapa. A strategy that uses rapid diagnostic tests (RDTs) to increase access to testing is being implemented in both Colombia and Guatemala, with RDT validation underway. In the US, Chagas screening programmes have been promoted through health fairs in Florida to improve access to testing. The iChagas app, which brings up-to-date information and critical knowledge to healthcare providers in diverse settings, was also launched in 2021. 

In Colombia, the project provided technical and scientific support for the creation of two new centres for the diagnosis and treatment of Chagas disease in the states of Arauca and Boyacá. In collaboration with the National Health Institute of Colombia and FIND, the project team elaborated a protocol for the validation of rapid tests in the country. In addition, community education activities to raise awareness about Chagas disease and COVID-19 were carried out in collaboration with local Colombian communities and health personnel.

In Brazil, along with partners including the State Health Secretary of Goias, DNDi supported the implementation of a national policy for reporting of chronic Chagas disease.

In the US, DNDi supported an expert group working on the development of screening recommendations and provided test kits and technical support to a new Chagas disease programme at the University of Florida.

In Guatemala, DNDi participated in a multi-partner project with the Guatemalan Ministry of Health, the University of San Carlos, Mundo Sano Foundation, and other partners. A seminar was held in Jutiapa with key stakeholders to identify the main barriers to care and develop a plan for addressing them. DNDi also provided scientific support for capacity strengthening of diagnosis and treatment for Chagas disease in the Guatemalan state of Jutiapa and donated diagnostic kits and other equipment to the National Reference Laboratory of Guatemala so that a nationwide diagnosis validation study could be implemented.