ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2019. Report of the Twelfth Meeting of the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases. Geneva, Switzerland: WHO. Available at: https://www.who.int/publications/m/item/twelfth-report-of-the-strategic-and-technical-advisory-group-for-neglected-tropical-diseases-(stag-ntds). Accessed May 29, 2021.
-
2.
Nunes MCP et al., 2018. Chagas cardiomyopathy: An update of current clinical knowledge and management: A scientific statement from the American Heart Association. Circulation 138: e169–e209.
-
3.
Gascon J , Bern C , Pinazo MJ , 2010. Chagas disease in Spain, the United States and other non-endemic countries. Acta Trop 115: 22–27.
-
4.
Irish A , Whitman JD , Clark EH , Marcus R , Bern C , 2022. Updated estimates and mapping for prevalence of Chagas disease among adults, United States. Emerg Infect Dis 28: 1313–1320.
-
5.
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.
-
6.
Hotez PJ et al., 2014. The global burden of disease study 2010: Interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis 8: e2865.
-
7.
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: 108–113.
-
8.
U.S. Food and Drug Administration , 2018. Center for Drug Evaluation and Research. Nifurtimox NDA 213464, Approval Letter. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/213464Orig1s000MultidisciplineR.pdf. Accessed May 1, 2024.
-
9.
Bern C et al., 2007. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA 298: 2171–2181.
-
10.
Morillo CA et al., 2015. Randomized trial of benznidazole for chronic Chagas’ cardiomyopathy. N Engl J Med 373: 1295–1306.
-
11.
Mora G , 2016. Chagas cardiomyopathy. E-J Cardiol Pract. Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Chagas-cardiomyopathy. Accessed June 4, 2021.
-
12.
Murcia L , Simón M , Carrilero B , Roig M , Segovia M , 2017. Treatment of infected women of childbearing age prevents congenital Trypanosoma cruzi infection by eliminating the parasitemia detected by PCR. J Infect Dis 215: 1452–1458.
-
13.
Álvarez MG , Vigliano C , Lococo B , Bertocchi G , Viotti R , 2017. Prevention of congenital Chagas disease by benznidazole treatment in reproductive-age women: An observational study. Acta Trop 174: 149–152.
-
14.
Stimpert KK , Montgomery SP , 2010. Physician awareness of Chagas disease, USA. Emerg Infect Dis 16: 871–872.
-
15.
Iglesias-Rus L , Romay-Barja M , Boquete T , Benito A , Blasco-Hernández T , 2019. The role of the first level of health care in the approach to Chagas disease in a non-endemic country. PLoS Negl Trop Dis 13: e0007937.
-
16.
Marcus R , Henao-Martínez AF , Nolan M , Livingston E , Klotz SA , Gilman RH , Miranda-Schaeubinger M , Meymandi S , 2021. Recognition and screening for Chagas disease in the USA. Ther Adv Infect Dis 8: 20499361211046086.
-
17.
Manne-Goehler J , Perez JH , Davis J , Hochberg N , Hamer D , Barnett E , Köhler J , 2017. Primary care-based screening for Trypanosoma cruzi in high-risk populations: Results of the strong hearts pilot in east Boston, Massachusetts. Open Forum Infect Dis 4 (Suppl 1 ):S120.
-
18.
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: 1182–1188.
-
19.
Edwards MS , Rench MA , Todd CW , Czaicki N , Steurer FJ , Bern C , Montgomery SP , 2015. Perinatal screening for Chagas disease in southern Texas. J Pediatric Infect Dis Soc 4: 67–70.
-
20.
Mahoney West H , Milliren CE , Manne-Goehler J , Davis J , Gallegos J , Perez JH , Köhler JR , 2022. Effect of clinician information sessions on diagnostic testing for Chagas disease. PLoS Negl Trop Dis 16: e0010524.
-
21.
Martínez Sanz J et al., 2019. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates. PLoS One 14: e0218380.
-
22.
Domino FJ , Chopra S , Seligman M , Sullivan K , Quirk ME , 2011. The impact on medical practice of commitments to change following CME lectures: A randomized controlled trial. Med Teach 33: e495–e500.
-
23.
Stone EG , Morton SC , Hulscher ME , Maglione MA , Roth EA , Grimshaw JM , Mittman BS , Rubenstein LV , Rubenstein LZ , Shekelle PG , 2002. Interventions that increase use of adult immunization and cancer screening services: A meta-analysis. Ann Intern Med 136: 641–651.
-
24.
Myers A , McCaskill SP , Van Ravenstein K , 2017. Improving STD screening rates on a university campus. J Community Health 42: 1247–1254.
-
25.
Wong K , Abdelqader A , Camire L , Farshidpour M , Singh S , Abuwalla Z , Weisman D , 2017. A resident initiative improves hepatitis C screening rates in primary care clinics. J Grad Med Educ 9: 768–770.
-
26.
Melki G et al., 2019. Re-educating residents about non-invasive colorectal cancer screening: An approach to improving colon cancer screening compliance. Gastroenterol Res 12: 312–314.
-
27.
Cook LA , Sachs J , Weiskopf NG , 2022. The quality of social determinants data in the electronic health record: A systematic review. J Am Med Inform Assoc 29: 187–196.
-
28.
Forsyth CJ et al., 2021. Recommendations for screening and diagnosis of Chagas disease in the United States. J Infect Dis 225: 1601–1610.
-
29.
Navarro M , Perez-Ayala A , Guionnet A , Perez-Molina JA , Navaza B , Estevez L , Norman F , Flores-Chávez M , Lopez-Velez R , 2011. Targeted screening and health education for Chagas disease tailored to at-risk migrants in Spain, 2007–2010. Euro Surveill 16: 19973.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 485 | 485 | 111 |
| Full Text Views | 49 | 49 | 8 |
| PDF Downloads | 55 | 55 | 12 |
Improving Clinician Awareness of and Screening for Chagas Disease with an Educational Intervention
Alyse Wheelock
Alyse Wheelock
Section of Preventive Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Search for other papers by Alyse Wheelock in
Current site
Google Scholar
PubMed
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Search for other papers by Alyse Wheelock in
Current site
Google Scholar
PubMed
Sukhmeet Sandhu
Sukhmeet Sandhu
Department of Medicine, Boston Medical Center, Boston, Massachusetts;
Search for other papers by Sukhmeet Sandhu in
Current site
Google Scholar
PubMed
Search for other papers by Sukhmeet Sandhu in
Current site
Google Scholar
PubMed
Katherine Reifler
Katherine Reifler
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Search for other papers by Katherine Reifler in
Current site
Google Scholar
PubMed
Search for other papers by Katherine Reifler in
Current site
Google Scholar
PubMed
Malwina Carrion
Malwina Carrion
Boston University Sargent College of Health and Rehabilitation Sciences, Boston, Massachusetts;
Search for other papers by Malwina Carrion in
Current site
Google Scholar
PubMed
Search for other papers by Malwina Carrion in
Current site
Google Scholar
PubMed
Daniel L. Bourque
Daniel L. Bourque
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Search for other papers by Daniel L. Bourque in
Current site
Google Scholar
PubMed
Search for other papers by Daniel L. Bourque in
Current site
Google Scholar
PubMed
Davidson H. Hamer
Davidson H. Hamer
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
Search for other papers by Davidson H. Hamer in
Current site
Google Scholar
PubMed
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
Center on Emerging Infectious Diseases, Boston University, Boston, Massachusetts
Search for other papers by Davidson H. Hamer in
Current site
Google Scholar
PubMed
Natasha S. Hochberg
Natasha S. Hochberg
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;
Search for other papers by Natasha S. Hochberg in
Current site
Google Scholar
PubMed
Search for other papers by Natasha S. Hochberg in
Current site
Google Scholar
PubMed
ABSTRACT.
Chagas disease is an underrecognized, chronic, and potentially life-threatening disease caused by the parasite Trypanosoma cruzi. We aimed to improve awareness and screening for Chagas disease among patients from endemic areas using a large safety-net academic hospital system in the United States. We developed an educational intervention consisting of a case-based didactic session presented to physicians, trainees, and other healthcare providers at conferences across different departments. Performance on a knowledge assessment administered before and after the presentation was analyzed with paired Student’s t-test for within-subject difference testing. Institutional testing rates for T. cruzi were evaluated for an equal time period (29 months) before and after the start of the intervention. Testing rates were compared by a Welch’s unequal variances t-test and by interrupted time series based on multivariate linear regression. Eleven educational sessions were held over the intervention period, and 103 participants completed the pre- and post-presentation surveys. The mean survey scores were 59.2% before the presentation and 96.6% after presentation (P <0.001). Trypanosoma cruzi testing during the postintervention period was significantly higher than testing during the pre-intervention period (171 patients pre-intervention versus 378 patients postintervention [P = 0.015]). Notable increases in testing from the pre-intervention to postintervention periods occurred among midwives (1–68 patients tested) and trainees (57–133 patients tested). Overall, 56/537 (10.4%) nonduplicate T. cruzi commercial screening tests were positive. Testing increased over time, both at an institutional level and within targeted departments. In addition to the educational program, other factors likely influenced expanded testing.
- Supplemental Materials (PDF 2002.8 KB)
Author Notes
Financial support: This study received support from
Disclosures: This study was approved by the Boston University Institutional Review Board, study number H-38367. The requirement for informed consent was waived.
Conflicts of interest: After completing this study, N. S. Hochberg was employed by Novartis BioMedical Research, for which she received a salary and stocks. N. S. Hochberg, D. L. Bourque, and D. H. Hamer have collaborated with Kephera Diagnostics on grants funding research for Chagas disease diagnostics and biomarkers. There are no other conflicts of interest to report.
Author’s contributions: A. Wheelock and S. Sandhu contributed equally to the manuscript. S. Sandhu, A. Wheelock, N. S. Hochberg, and D. H. Hamer conceived of the study design. S. Sandhu, A. Wheelock, N. S. Hochberg, D. H. Hamer, K. Reifler, and D. L. Bourque performed the educational sessions and administered the pre- and posttests. A. Wheelock and S. Sandhu drafted the manuscript and incorporated feedback. M. Carrion, K. Reifler, N. S. Hochberg, and D. H. Hamer edited the manuscript. All authors read and approved the final manuscript.
Current contact information: Alyse Wheelock, 20 University Road, Suite 500 Cambridge, MA, E-mail: alyse.wheelock@gmail.com. Sukhmeet Sandhu, Department of Medicine, Boston Medical Center, Boston, MA, E-mail: sksandhu214@gmail.com. Katherine Reifler and Daniel L. Bourque, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, E-mails: katherine.reifler@bmc.org and daniel.bourque@bmc.org. Malwina Carrion, Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA, E-mail: maja@bu.edu. Davidson H. Hamer, Department of Global Health, Boston University School of Public Health, Boston, MA, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, and Center on Emerging Infectious Diseases, Boston University, Boston, MA, E-mail: dhamer@bu.edu. Natasha S. Hochberg, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, and Department of Epidemiology, Boston University School of Public Health, Boston, MA, E-mail: nhoch@bu.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2019. Report of the Twelfth Meeting of the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases. Geneva, Switzerland: WHO. Available at: https://www.who.int/publications/m/item/twelfth-report-of-the-strategic-and-technical-advisory-group-for-neglected-tropical-diseases-(stag-ntds). Accessed May 29, 2021.
-
2.
Nunes MCP et al., 2018. Chagas cardiomyopathy: An update of current clinical knowledge and management: A scientific statement from the American Heart Association. Circulation 138: e169–e209.
-
3.
Gascon J , Bern C , Pinazo MJ , 2010. Chagas disease in Spain, the United States and other non-endemic countries. Acta Trop 115: 22–27.
-
4.
Irish A , Whitman JD , Clark EH , Marcus R , Bern C , 2022. Updated estimates and mapping for prevalence of Chagas disease among adults, United States. Emerg Infect Dis 28: 1313–1320.
-
5.
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.
-
6.
Hotez PJ et al., 2014. The global burden of disease study 2010: Interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis 8: e2865.
-
7.
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: 108–113.
-
8.
U.S. Food and Drug Administration , 2018. Center for Drug Evaluation and Research. Nifurtimox NDA 213464, Approval Letter. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/213464Orig1s000MultidisciplineR.pdf. Accessed May 1, 2024.
-
9.
Bern C et al., 2007. Evaluation and treatment of Chagas disease in the United States: A systematic review. JAMA 298: 2171–2181.
-
10.
Morillo CA et al., 2015. Randomized trial of benznidazole for chronic Chagas’ cardiomyopathy. N Engl J Med 373: 1295–1306.
-
11.
Mora G , 2016. Chagas cardiomyopathy. E-J Cardiol Pract. Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Chagas-cardiomyopathy. Accessed June 4, 2021.
-
12.
Murcia L , Simón M , Carrilero B , Roig M , Segovia M , 2017. Treatment of infected women of childbearing age prevents congenital Trypanosoma cruzi infection by eliminating the parasitemia detected by PCR. J Infect Dis 215: 1452–1458.
-
13.
Álvarez MG , Vigliano C , Lococo B , Bertocchi G , Viotti R , 2017. Prevention of congenital Chagas disease by benznidazole treatment in reproductive-age women: An observational study. Acta Trop 174: 149–152.
-
14.
Stimpert KK , Montgomery SP , 2010. Physician awareness of Chagas disease, USA. Emerg Infect Dis 16: 871–872.
-
15.
Iglesias-Rus L , Romay-Barja M , Boquete T , Benito A , Blasco-Hernández T , 2019. The role of the first level of health care in the approach to Chagas disease in a non-endemic country. PLoS Negl Trop Dis 13: e0007937.
-
16.
Marcus R , Henao-Martínez AF , Nolan M , Livingston E , Klotz SA , Gilman RH , Miranda-Schaeubinger M , Meymandi S , 2021. Recognition and screening for Chagas disease in the USA. Ther Adv Infect Dis 8: 20499361211046086.
-
17.
Manne-Goehler J , Perez JH , Davis J , Hochberg N , Hamer D , Barnett E , Köhler J , 2017. Primary care-based screening for Trypanosoma cruzi in high-risk populations: Results of the strong hearts pilot in east Boston, Massachusetts. Open Forum Infect Dis 4 (Suppl 1 ):S120.
-
18.
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: 1182–1188.
-
19.
Edwards MS , Rench MA , Todd CW , Czaicki N , Steurer FJ , Bern C , Montgomery SP , 2015. Perinatal screening for Chagas disease in southern Texas. J Pediatric Infect Dis Soc 4: 67–70.
-
20.
Mahoney West H , Milliren CE , Manne-Goehler J , Davis J , Gallegos J , Perez JH , Köhler JR , 2022. Effect of clinician information sessions on diagnostic testing for Chagas disease. PLoS Negl Trop Dis 16: e0010524.
-
21.
Martínez Sanz J et al., 2019. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates. PLoS One 14: e0218380.
-
22.
Domino FJ , Chopra S , Seligman M , Sullivan K , Quirk ME , 2011. The impact on medical practice of commitments to change following CME lectures: A randomized controlled trial. Med Teach 33: e495–e500.
-
23.
Stone EG , Morton SC , Hulscher ME , Maglione MA , Roth EA , Grimshaw JM , Mittman BS , Rubenstein LV , Rubenstein LZ , Shekelle PG , 2002. Interventions that increase use of adult immunization and cancer screening services: A meta-analysis. Ann Intern Med 136: 641–651.
-
24.
Myers A , McCaskill SP , Van Ravenstein K , 2017. Improving STD screening rates on a university campus. J Community Health 42: 1247–1254.
-
25.
Wong K , Abdelqader A , Camire L , Farshidpour M , Singh S , Abuwalla Z , Weisman D , 2017. A resident initiative improves hepatitis C screening rates in primary care clinics. J Grad Med Educ 9: 768–770.
-
26.
Melki G et al., 2019. Re-educating residents about non-invasive colorectal cancer screening: An approach to improving colon cancer screening compliance. Gastroenterol Res 12: 312–314.
-
27.
Cook LA , Sachs J , Weiskopf NG , 2022. The quality of social determinants data in the electronic health record: A systematic review. J Am Med Inform Assoc 29: 187–196.
-
28.
Forsyth CJ et al., 2021. Recommendations for screening and diagnosis of Chagas disease in the United States. J Infect Dis 225: 1601–1610.
-
29.
Navarro M , Perez-Ayala A , Guionnet A , Perez-Molina JA , Navaza B , Estevez L , Norman F , Flores-Chávez M , Lopez-Velez R , 2011. Targeted screening and health education for Chagas disease tailored to at-risk migrants in Spain, 2007–2010. Euro Surveill 16: 19973.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 485 | 485 | 111 |
| Full Text Views | 49 | 49 | 8 |
| PDF Downloads | 55 | 55 | 12 |