1921
Volume 93, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

There are 300,000 estimated cases of Chagas disease in the United States but limited data on access to care. This study analyzed trends in access to care for Chagas disease in the United States and assessed the national and state barriers to access. Data on cases in blood donors and drug releases were obtained from the AABB (formerly American Association of Blood Banks) and U.S. Centers for Disease Control and Prevention (CDC), respectively. Semi-structured in-depth interviews were conducted with 30 key informants at the national level and in five states where treatment had been released. Interview responses were analyzed according to the health systems dimensions of regulation, financing, payment, organization, and persuasion. Data indicate that 1,908 cases were identified in the blood donation system from 2007 to 2013 and that CDC released 422 courses of benznidazole or nifurtimox during this period. The barriers to access at the national level include limited diagnostic and institutionalized referral and care processes, lack of financing for patient-care activities, and limited awareness and training among providers. This study demonstrates that access to treatment of Chagas disease in the United States is limited. The lack of licensing is only one of several barriers to access, highlighting the need for a health systems perspective when scaling up access to these essential medicines.

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2015-07-08
2017-11-20
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References

  1. Mathers CD, Ezzati M, Lopez AD, , 2007. Measuring the burden of neglected tropical diseases: the global burden of disease framework. PLoS Negl Trop Dis 1: e114.[Crossref]
  2. Bern C, Montgomery SP, Herwaldt BL, Rassi A, Marin-Neto JA, Dantas RO, Maguire JH, Acquatella H, Morillo C, Kirchhoff LV, Gilman GH, Reyes PA, Salvatella R, Moore AC, , 2007. Evaluation and treatment of Chagas disease in the United States: a systematic review. JAMA 298: 21712181.[Crossref]
  3. Manne JM, Snively CS, Ramsey JM, Salgado MO, Bärnighausen T, Reich MR, , 2013. Barriers to treatment access for Chagas disease in Mexico. PLoS Negl Trop Dis 7: e2488.[Crossref]
  4. Albajar-Vinas P, Dias JC, , 2014. Advancing the treatment for Chagas' disease. N Engl J Med 370: 19421943.[Crossref]
  5. Ribeiro I, Sevcsik A-M, Alves F, Diap G, Don R, Harhay MO, Chang S, Pecoul B, , 2009. New, improved treatments for Chagas disease: from the R and D pipeline to the patients. PLoS Negl Trop Dis 3: e484.[Crossref]
  6. Gascon J, Bern C, Pinazo MJ, , 2010. Chagas disease in Spain, the United States and other non-endemic countries. Acta Trop 115: 2227.[Crossref]
  7. Bern C, Montgomery SP, , 2009. An estimate of the burden of Chagas disease in the United States. Clin Infect Dis 49: e52e54.[Crossref]
  8. Albajar-Vinas P, Jannin J, , 2011. The hidden Chagas disease burden in Europe. Euro Surveill 16: 24.
  9. Verani JR, Montgomery SP, Schulkin J, Anderson B, Jones JL, , 2010. Survey of obstetrician-gynecologists in the United States about Chagas disease. Am J Trop Med Hyg 83: 891895.[Crossref]
  10. Roberts MJ, Hsiao W, Berman P, Reich MR, , 2004. Getting Health Reform Right: A Guide to Improving Performance and Equity. Oxford, United Kingdom: Oxford University Press.
  11. Frost LJ, Reich MR, , 2008. Access: How Do Good Health Technologies Get to Poor People in Poor Countries. Cambridge, MA: Harvard Center for Population and Development Studies, distributed by Harvard University Press.
  12. Yun O, Lima MA, Ellman T, Chambi W, Castillo S, Flevaud L, Roddy P, Parreño F, Viñas PA, Palma PP, , 2009. Feasibility, drug safety, and effectiveness of etiological treatment programs for Chagas disease in Honduras, Guatemala, and Bolivia: 10-year experience of Medecins Sans Frontieres. PLoS Negl Trop Dis 3: e488.[Crossref]
  13. Bern C, , 2011. Antitrypanosomal therapy for chronic Chagas' disease. N Engl J Med 364: 25272534.[Crossref]
  14. Viotti R, Vigliano C, Lococo B, Bertocchi G, Petti M, Alvarez MG, Postan M, Armenti A, , 2006. Long-term cardiac outcomes of treating chronic Chagas disease with benznidazole versus no treatment: a nonrandomized trial. Ann Intern Med 144: 724734.[Crossref]
  15. American Association of Blood Banks, 2013. AABB Confirmed Chagas Cases, 2007–Present. Bethesda, MD: American Association of Blood Banks.
  16. United States Centers for Disease Control and Prevention Drug Service, 2014. Drug Releases for Chagas disease in the United States, 1992–Present. Atlanta, GA: United States Centers for Disease Control and Prevention.
  17. U.S. Food and Drug Administration, 2014. CFR—Code of Federal Regulations Title 21. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=312. Accessed June 4, 2014.
  18. Stimpert KK, Montgomery SP, , 2010. Physician awareness of Chagas disease, USA. Emerg Infect Dis 16: 871872.[Crossref]
  19. Global Funding of Innovation for Neglected Diseases, 2013. Neglected Disease Research and Development: The Public Divide. Sydney, Australia: Policy Cures.
  20. James AB, Hillyer CD, Shaz BH, , 2012. Demographic differences in estimated blood donor eligibility prevalence in the United States. Transfusion 52: 10501061.[Crossref]
  21. Garcia MN, Aguilar D, Gorchakov R, Rossmann SN, Montgomery SP, Rivera H, Woc-Colburn L, Hotez PJ, Murray KO, , 2015. Evidence of autochthonous Chagas disease in southeastern Texas. Am J Trop Med Hyg 92: 325330.[Crossref]
  22. Montgomery SP, Starr MC, Cantey PT, Edwards MS, Meymandi SK, , 2014. Neglected parasitic infections in the United States: Chagas disease. Am J Trop Med Hyg 90: 814818.[Crossref]
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  • Received : 21 Dec 2014
  • Accepted : 26 Mar 2015

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