Improving access to Chagas disease diagnosis and etiologic treatment in remote rural communities of the Argentine Chaco through strengthened primary health care and broad social participation

Background
Rural populations in the Gran Chaco region have large prevalence rates of Trypanosoma cruzi infection and very limited access to diagnosis and treatment. We implemented an innovative strategy to bridge these gaps in 13 rural villages of Pampa del Indio held under sustained vector surveillance and control.
Methodology
The non-randomized treatment program included participatory workshops, capacity strengthening of local health personnel, serodiagnosis, qualitative and quantitative PCRs, a 60-day treatment course with benznidazole and follow-up. Parents and healthcare agents were instructed on drug administration and early detection and notification of adverse drug-related reactions (ADR). Healthcare agents monitored medication adherence and ADRs at village level.
Principal findings
The seroprevalence of T. cruzi infection was 24.1% among 395 residents up to 18 years of age examined. Serodiagnostic (70%) and treatment coverage (82%) largely exceeded local historical levels. Sixty-six (85%) of 78 eligible patients completed treatment with 97% medication adherence. ADRs occurred in 32% of patients, but most were mild and manageable. Four patients showing severe or moderate ADRs required treatment withdrawal. T. cruzi DNA was detected by qPCR in 47 (76%) patients before treatment, and persistently occurred in only one patient over 20–180 days posttreatment.
Conclusions and significance
Our results demonstrate that diagnosis and treatment of T. cruzi infection in remote, impoverished rural areas can be effectively addressed through strengthened primary healthcare attention and broad social participation with adequate external support. This strategy secured high treatment coverage and adherence; effectively managed ADRs, and provided early evidence of positive therapeutic responses.

研究背景
格兰查科（Gran Chaco）地区的农村人群克氏锥虫（Trypanosoma cruzi）感染率居高不下，且诊断与治疗资源极度匮乏。本研究针对潘帕德尔因迪奥（Pampa del Indio）13个持续开展媒介监测与防控的乡村村落，实施了一项创新性策略以填补上述医疗缺口。

研究方法
本非随机化治疗项目涵盖参与式研讨会、当地卫生人员能力建设、血清学诊断、定性与定量聚合酶链反应（PCR）、为期60天的苯硝唑（benznidazole）治疗疗程及随访工作。研究人员向患儿家长及医疗专员讲解了药物服用方法、药物不良反应（ADR）的早期识别与上报流程。医疗专员在村落层面监测患者服药依从性及药物不良反应发生情况。

主要研究结果
本次共纳入395名18岁及以下常住居民进行检测，其中克氏锥虫感染血清阳性率为24.1%。血清学诊断覆盖率（70%）与治疗覆盖率（82%）均大幅超过当地历史水平。78名符合入组标准的患者中，66名（85%）完成了全程治疗，服药依从率达97%。32%的患者出现药物不良反应，多数症状轻微且易于处理；其中4名出现中重度药物不良反应的患者需终止治疗。治疗前，通过定量PCR（qPCR）在47名（76%）患者体内检出克氏锥虫DNA，仅1名患者在治疗后20~180天内持续检出该病原体DNA。

结论与意义
本研究结果表明，在偏远贫困的农村地区，通过强化基层医疗服务、结合广泛的社会参与并辅以充足的外部支持，可有效解决克氏锥虫感染的诊断与治疗难题。该策略实现了较高的治疗覆盖率与服药依从性，对药物不良反应进行了有效管控，并为良好的治疗应答提供了早期证据。