Repetto Ernestina Carla, Zachariah Rony, Kumar Ajay, Angheben Andrea, Gobbi Federico, Anselmi Mariella, Al Rousan Ahmad, Torrico Carlota, Ruiz Rosa, Ledezma Gabriel, Buoninsegna Maria Chiara, Khogali Mohammed, Van den Bergh Rafael, De Maio Gianfranco, Egidi Ada Maristella, Maccagno Barbara, Garelli Silvia
Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg, Luxembourg.
PLoS Negl Trop Dis. 2015 Sep 25;9(9):e0004103. doi: 10.1371/journal.pntd.0004103. eCollection 2015 Sep.
Chagas disease (CD) represents a growing problem in Europe; Italy is one of the most affected countries but there is no national framework for CD and access-to-care is challenging. In 2012 Médecins Sans Frontières (MSF) started an intervention in Bergamo province, where many people of Latin American origin (PLAO) are resident. A new model-of-care for CD, initiated by Centre for Tropical Diseases of Sacro Cuore Hospital, Negrar (CTD), the NGO OIKOS and the Bolivian community since 2009 in the same area, was endorsed. Hereby, we aim to describe the prevalence of CD and the treatment management outcomes among PLAO screened from 1st June 2012 to 30th June 2013.
Retrospective cohort study using routine program data. Screening sessions were done in Bergamo at OIKOS outpatient service and serological confirmation, staging and treatment for CD was offered at the CTD. MSF provided health education on CD, awareness generation prior to screening days, pre-test and post-test counselling through cultural mediators of Latin American origin.
Of 1305 PLAO screened, 223(17%) had CD. Among 210 patients eligible for treatment, 102(49%) were lost-to-follow-up before treatment. The median delay from diagnosis to treatment was 4 months (range 0.7-16.6 months). Among 108 started on treatment, 63(58%) completed treatment, 36(33%) interrupted treatment, (33 for drug side-effects, two for patients decision and one due to pregnancy), 6(6%) were lost-to-follow-up and 3(3%) were on treatment at study censuring.
In this first study focusing on process of care for CD in Italy, less than 30% of patients completed treatment with drop-outs along the cascade of care. There is an urgent need to involve affected communities and local regional health authorities to take part to this model-of-care, adapting it to the local epidemiology. The Italian health authorities should take steps in advocating for a change in the current paradigm.
恰加斯病（CD）在欧洲已成为一个日益严重的问题；意大利是受影响最严重的国家之一，但该国没有针对恰加斯病的国家框架，获得医疗服务具有挑战性。2012年，无国界医生组织（MSF）在贝加莫省启动了一项干预措施，该省有许多拉丁裔居民（PLAO）。自2009年以来，由内格拉尔圣心医院热带病中心（CTD）、非政府组织奥ikos和玻利维亚社区发起的一种新的恰加斯病护理模式在同一地区得到认可。在此，我们旨在描述2012年6月1日至2013年6月30日期间接受筛查的拉丁裔居民中恰加斯病的患病率和治疗管理结果。
使用常规项目数据进行回顾性队列研究。在贝加莫的奥ikos门诊服务中心进行筛查，并在CTD进行恰加斯病的血清学确认、分期和治疗。无国界医生组织通过拉丁裔文化调解人提供关于恰加斯病的健康教育，在筛查日前提高认识，进行检测前和检测后咨询。
在1305名接受筛查的拉丁裔居民中，223人（17%）患有恰加斯病。在210名符合治疗条件的患者中，102人（49%）在治疗前失访。从诊断到治疗的中位延迟时间为4个月（范围0.7 - 16.6个月）。在108名开始治疗的患者中，63人（58%）完成治疗，36人（33%）中断治疗（33人因药物副作用，2人因患者决定，1人因怀孕），6人（6%）失访，3人（3%）在研究审查时仍在接受治疗。
在这项意大利首次关注恰加斯病护理过程的研究中，不到30%的患者完成治疗，在整个护理过程中存在患者退出的情况。迫切需要让受影响社区和地方区域卫生当局参与这种护理模式，并使其适应当地流行病学情况。意大利卫生当局应采取措施倡导改变当前模式。
