1921
Volume 98, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Chagas disease (CD) affects > 6 million people globally, including > 300,000 in the United States. Although early detection and etiological treatment prevents chronic complications from CD, < 1% of U.S. cases have been diagnosed and treated. This study explores access to etiological treatment from the perspective of patients with CD. In semi-structured interviews with 50 Latin American–born patients of the Center of Excellence for Chagas Disease at the Olive View–UCLA Medical Center, we collected demographic information and asked patients about their experiences managing the disease and accessing treatment. Patients were highly marginalized, with 63.4% living below the U.S. poverty line, 60% lacking a high school education, and only 12% with private insurance coverage. The main barriers to accessing health care for CD were lack of providers, precarious insurance coverage, low provider awareness, transportation difficulties, and limited time off. Increasing access to diagnosis and treatment will not only require a dramatic increase in provider and public education, but also development of programs which are financially, linguistically, politically, and geographically accessible to patients.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0691
2018-01-29
2019-12-08
Loading full text...

Full text loading...

/deliver/fulltext/14761645/98/3/tpmd170691.html?itemId=/content/journals/10.4269/ajtmh.17-0691&mimeType=html&fmt=ahah

References

  1. World Health Organization, 2015. Chagas disease in Latin America: an epidemiological update based on 2010 estimates. Wkly Epidemiol Rec 90: 3343. [Google Scholar]
  2. Manne-Goehler J, Umeh CA, Montgomery SP, Wirtz VJ, , 2016. Estimating the burden of Chagas disease in the United States. PLoS Negl Trop Dis 10: e0005033. [Google Scholar]
  3. World Health Organization, 2014. Global Health Estimates (GHE) 2014 Summary Tables. Geneva, Switzerland: World Health Organization.
  4. Rassi A, Jr Rassi A, Marin-Neto JA, , 2010. Chagas disease. Lancet 375: 13881402. [Google Scholar]
  5. 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. [Google Scholar]
  6. Fabbro DL, Streiger ML, Arias ED, Bizai ML, del Barco M, Amicone NA, , 2007. Trypanocide treatment among adults with chronic Chagas disease living in Santa Fe city (Argentina), over a mean follow-up of 21 years: parasitological, serological and clinical evolution. Rev Soc Bras Med Trop 40: 110. [Google Scholar]
  7. Fabbro DL, Danesi E, Olivera V, Codebó MO, Denner S, Heredia C, Streiger M, Sosa-Estani S, , 2014. Trypanocide treatment of women infected with Trypanosoma cruzi and its effect on preventing congenital Chagas. PLoS Negl Trop Dis 8: e3312. [Google Scholar]
  8. 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. [Google Scholar]
  9. Manne-Goehler J, Reich MR, Wirtz VJ, , 2015. Access to care for Chagas disease in the United States: a health systems analysis. Am J Trop Med Hyg 93: 108113. [Google Scholar]
  10. Cucunubá ZM, Manne-Goehler JM, Díaz D, Nouvellet P, Bernal O, Marchiol A, Basáñez MG, Conteh L, , 2017. How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis. Soc Sci Med 175: 187198. [Google Scholar]
  11. Basile L, Working Group on Chagas Disease; , 2011. Chagas disease in European countries: the challenge of a surveillance system. Euro Surveill 16: pii: 19968. [Google Scholar]
  12. Hernandez S, Flores CA, Viana GM, Sanchez DR, Traina MI, Meymandi SK, , 2016. Autochthonous transmission of Trypanosoma cruzi in southern California. Open Forum Infect Dis 3: ofw227. [Google Scholar]
  13. 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. [Google Scholar]
  14. Klotz SA, Dorn PL, Mosbacher M, Schmidt JO, , 2014. Kissing bugs in the United States: risk for vector-borne disease in humans. Environ Health Insights 8: 4959. [Google Scholar]
  15. Dittmar K, Jansen AM, Araújo A, Reinhard K, , 2003. Molecular diagnosis of prehistoric T. cruzi in the Texas-Coahuila border region. Thirteenth Annual Meeting of the Paleopathology Association, Tempe, Arizona. Paleopathol Newsl (Suppl.) 4:4. [Google Scholar]
  16. Stimpert KK, Montgomery SP, , 2010. Physician awareness of Chagas disease, USA. Emerg Infect Dis 16: 871872. [Google Scholar]
  17. 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. [Google Scholar]
  18. Amstutz-Szalay S, , 2017. Physician knowledge of Chagas disease in hispanic immigrants living in Appalachian Ohio. J Racial Ethn Health Disparities 4: 523528. [Google Scholar]
  19. Miller DA, Hernandez S, Rodriguez De Armas L, Eells SJ, Traina MM, Miller LG, Meymandi SK, , 2015. Tolerance of benznidazole in a United States Chagas disease clinic. Clin Infect Dis 60: 12371240. [Google Scholar]
  20. Forsyth CJ, Hernandez S, Olmedo W, Abuhamidah A, Traina MI, Sanchez DR, Soverow J, Meymandi SK, , 2016. Safety profile of nifurtimox for treatment of Chagas disease in the United States. Clin Infect Dis 63: 10561062. [Google Scholar]
  21. Bern C, 2007. Evaluation and treatment of Chagas disease in the United States: a systematic review. JAMA 298: 21712181. [Google Scholar]
  22. Dias JCP, 2016. 2nd Brazilian consensus on Chagas disease, 2015. Rev Soc Bras Med Trop 49 (Suppl 1): 360. [Google Scholar]
  23. Minneman RM, Hennink MM, Nicholls A, Salek SS, Palomeque FS, Khawja A, Albor LC, Pennock CC, Leon JS, , 2012. Barriers to testing and treatment for Chagas disease among Latino immigrants in Georgia. J Parasitol Res 2012: 295034. [Google Scholar]
  24. Sanchez DR, Traina MI, Hernandez S, Smer AM, Khamag H, Meymandi SK, , 2014. Chagas disease awareness among Latin American immigrants living in Los Angeles, California. Am J Trop Med Hyg 91: 915919. [Google Scholar]
  25. Meymandi SK, Hernandez S, Forsyth CJ, , 2017. A community-based screening program for Chagas disease in the USA. Trends Parasitol 33: 828831. [Google Scholar]
  26. Meymandi SK, Forsyth CJ, Soverow J, Hernandez S, Sanchez D, Montgomery SP, Traina M, , 2017. Prevalence of Chagas disease in the Latin American-born population of Los Angeles. Clin Infect Dis 64: 11821188. [Google Scholar]
  27. Pew Research Center, 2011. Hispanic Population in Select U.S. Metropolitan Areas. Washington, DC: Pew Research Center.
  28. Charmaz K, , 1990. ‘Discovering’ chronic illness: using grounded theory. Soc Sci Med 30: 11611172. [Google Scholar]
  29. Lucia L, Dietz M, Jacobs K, Chen X, Kominski GF, , 2015. Which Californians Will Lack Health Insurance under the Affordable Care Act? Los Angeles, CA and Berkeley, CA: UCLA Center for Health Policy Research and UC Berkeley Labor Center.
  30. Zong J, Batalova J, , 2016. Mexican Immigrants in the United States. Washington, DC: Migration Policy Institute.
  31. Chavez LR, , 2012. Undocumented immigrants and their use of medical services in Orange County, California. Soc Sci Med 74: 887893. [Google Scholar]
  32. Briceño-León R, , 2009. La enfermedad de Chagas en las Américas: una perspectiva de ecosalud. Cad Saúde Pública 25: S71S82. [Google Scholar]
  33. Jackson Y, Castillo S, Hammond P, Besson M, Brawand-Bron A, Urzola D, Gaspoz JM, Chappuis F, , 2012. Metabolic, mental health, behavioural and socioeconomic characteristics of migrants with Chagas disease in a non-endemic country. Trop Med Int Health 17: 595603. [Google Scholar]
  34. Viotti R, Vigliano CA, Álvareza MG, Lococo BE, Petti MA, Bertocchi GL, Armenti AH, , 2009. El impacto de las condiciones socioeconómicas en la evolución de la enfermedad de Chagas crónica. Rev Esp Cardiol 62: 12241232. [Google Scholar]
  35. Forsyth C, , 2015. Controlled but not cured: structural processes and explanatory models of Chagas disease in tropical Bolivia. Soc Sci Med 145: 716. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0691
Loading
/content/journals/10.4269/ajtmh.17-0691
Loading

Data & Media loading...

  • Received : 31 Aug 2017
  • Accepted : 10 Dec 2017
  • Published online : 29 Jan 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error