Bridging the gap in Chagas disease management: a mixed-methods study using an implementation science approach within the Brazilian primary health care system—‘Implementa-Chagas/SaMi-Trop project’
Year: 2025
Type: article
Abstract: Background: Chagas Disease (ChD), a prevalent Neglected Tropical Disease in Latin America, affects millions and poses significant challenges in Brazil's primary healthcare system. Despite the availability of diagnostic tools and effective drugs, screening and treatment rates remain alarmingly low. This study aims to identify barriers and facilitators in ChD management, focusing on integrating services into routine healthcare operations. Methods: An exploratory sequential mixed-methods approach was used, combining focus groups with primary care physicians, in-depth interviews, and quantitative surveys with healthcare professionals. The Theoretical Domains Framework (TDF) and the Capability Opportunity Motivation-Behaviour (COM-B) model guided the analysis of decision-making processes in ChD management. Intervention strategies were developed using the Behaviour Change Wheel (BCW) framework, emphasizing educational programmes, hands-on training, and infrastructural improvements. Findings: The study identified key barriers, including limited awareness of ChD among healthcare professionals, reliance on symptomatic diagnosis, environmental constraints, and inadequate public and professional engagement with ChD. We proposed tailored interventions to enhance primary healthcare personnel competencies through education, training, and infrastructure adjustments. Interpretation: The study advocates for a paradigm shift in ChD management towards early intervention and comprehensive care. It highlights the importance of a team-based strategy aligned with the WHO's Neglected Tropical Diseases roadmap, particularly in remote areas. This approach addresses healthcare workers' challenges, fostering a more proactive and informed ChD management strategy. Funding: The NIH supported the study under the Sami-Trop cohort study (Grant n. U01AI168383).
Authors: Carlos Henrique Valente Moreira, Laura Azevedo, Ariela Mota Ferreira, Ana Carolina Gonçalves Oliveira, Andréia Brito de Souza, Desirée Sant’Ana Haikal, Cláudia Di Lorenzo Oliveira, Clareci Silva Cardoso, Matthew Spinelli, Ana Luiza Bierrenbach, Nayara Dornela Quintino, Nayara Ragi Baldoni, Renata Fiuza Damasceno, Malu Ribeiro Drumond, Thallyta Maria Vieira, Dardiane Santos Cruz, Sâmara Fernandes Leite, Ana Clara de Jesus Santos, Léa Campos de Oliveira Silva, Renata Buccheri, Antônio Luiz Pinho Ribeiro, Ester Cerdeira Sabino
Institutions: San Francisco General Hospital, Universidade de São Paulo, University of California, San Francisco, Sutter Santa Rosa Regional Hospital, Universidade Estadual de Montes Claros, Federal University of São João del-Rei, Hospital Sírio-Libanês, Secretaria de Estado de Saúde de Minas Gerais, Universidade de Itaúna, Vitalant Research Institute, Universidade Federal de Minas Gerais, Hospital das Clínicas da Universidade Federal de Minas Gerais
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,930
Awards: G1199558664, G188393402, G379581663, G5905040377, G6447106410, Sao Paulo-Minas Gerais Tropical Medicine Research Center for Chagas Disease Biomarker Discovery, "Sao Paulo-Minas Gerais Center for Chagas Disease Treatment (SaMiTrop)", Randomized Directly Observed Therapy Study to Interpret Clinical Trials of Doxy-PEP
OpenAlex ID: W4411120437