Improving Clinician Awareness of and Screening for Chagas Disease with an Educational Intervention

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;

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Sukhmeet Sandhu Department of Medicine, Boston Medical Center, Boston, Massachusetts;

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Katherine Reifler Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;

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Malwina Carrion Boston University Sargent College of Health and Rehabilitation Sciences, Boston, Massachusetts;

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Daniel L. Bourque Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;

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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

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Natasha S. Hochberg Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts;

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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.

Author Notes

Financial support: This study received support from CDC grant No. NU2GGH002322-01-00 (INSECT grant). A. Wheelock was supported by training grant NIH T32HL125232-07. K. Reifler was supported by training grant NIH 5T32AI052074-17.

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.

Authors’ addresses: 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.

Address correspondence to Alyse Wheelock, M.D., 20 University Rd., Suite 500, Cambridge, MA 02138. E-mail: alyse.wheelock@gmail.com
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