Demonstrate the feasibility of scaling up access to diagnosis and treatment in pilot projects that can then be replicated on a larger scale
current phase of drug development
updated 16 Feb 2023
In 2015, DNDi launched the Chagas Access Project to increase access to diagnosis and treatment for Chagas disease. Working in collaboration with local, regional, and national partners in several endemic countries, DNDi has launched a series of projects to pilot new models of patient-centred care with a test-and-treat approach.
The new patient-centred approach was first implemented in Colombia in collaboration with the Ministry of Health and Social Protection (MSPS), the Colombian National Health Institute (INS), and other partners working together to support the implementation of a comprehensive roadmap for Chagas care. In four Colombian departments where Chagas disease is highly endemic, the projects have increased access to testing and treatment by training healthcare staff on the most up-to-date treatment guidelines; simplifying and accelerating the procedure for diagnosis; and decentralizing treatment so that it would be available closer to where patients live.
The collaborative work carried out by the MSPS, local health systems, and DNDi in the project areas produced robust results. When comparing access to care for Chagas disease before and after implementation of the pilot projects, several improvements were made:
- The average number of people tested annually increased nearly five-fold, from 426 before the project to 2427 after its implementation
- The average number of cases of Chagas disease detected per year increased from 37 to 262, meaning more people could receive timely care
- Average wait times for confirmation of diagnosis decreased by over 90%, from 258 to 19 days
- Average wait times between confirmed diagnosis and start of treatment decreased by over 60%, from 354 days to 135
In the United States, DNDi has also collaborated with the Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center in Los Angeles on work to identify the main barriers to treatment access and promote of testing and treatment. Through the project, the first large-scale prevalence study on Chagas disease in a major US city was published, describing findings from the Center’s community screening programme in Los Angeles. The project also conducted research with patients in Los Angeles to understand the main barriers to accessing treatment and care.
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.
Ending the neglect of Chagas in Colombia
Bringing Chagas disease care to a remote Colombian region
News & resources
- 29 October 2021 - On-site experience of a project to increase access to diagnosis and treatment of Chagas disease in high-risk endemic areas of Colombia, Acta Tropica
- 31 January 2021 - Chagas Access
- 1 December 2019 - Improving access to testing for Chagas disease in Colombia
- 20 June 2019 - Chagas Access Programme achieves an increase of 1300% in the number of people screened
- 5 September 2018 - DNDi and Fiocruz launch project to expand access to diagnosis and treatment for Chagas disease in Brazil
- 14 April 2018 - DNDi agreement with Colombia Ministry of Health and Social Welfare to guarantee access to comprehensive care for Chagas patients
- 14 April 2018 - Ending the neglect of Chagas
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