Sartor Paula, Colaianni Ivana, Cardinal M Victoria, Bua Jacqueline, Freilij Héctor, Gürtler Ricardo E
Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Ecología, Genética y Evolución de Buenos Aires (IEGEBA), Facultad de Ciencias Exactas y Naturales, Buenos Aires, Argentina.
Dirección de Epidemiología, Ministerio de Salud de la Provincia del Chaco, Chaco, Argentina.
PLoS Negl Trop Dis. 2017 Feb 13;11(2):e0005336. doi: 10.1371/journal.pntd.0005336. eCollection 2017 Feb.
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.
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.
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.
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.
格兰查科地区的农村人口中克氏锥虫感染率很高，且获得诊断和治疗的机会非常有限。我们在潘帕德尔印第奥的13个农村村庄实施了一项创新战略，这些村庄处于持续的病媒监测和控制之下，以弥合这些差距。
非随机治疗方案包括参与性研讨会、加强当地卫生人员的能力、血清学诊断、定性和定量聚合酶链反应、为期60天的苯硝唑治疗疗程以及随访。指导家长和医疗保健人员药物管理以及药物相关不良反应（ADR）的早期发现和报告。医疗保健人员在村庄层面监测药物依从性和ADR。
在接受检查的395名18岁及以下居民中，克氏锥虫感染的血清阳性率为24.1%。血清学诊断覆盖率（70%）和治疗覆盖率（82%）大大超过了当地历史水平。78名符合条件的患者中有66名（85%）完成了治疗，药物依从率为97%。32%的患者出现了ADR，但大多数为轻度且可控制。4名出现严重或中度ADR的患者需要停药。治疗前通过定量聚合酶链反应在47名（76%）患者中检测到克氏锥虫DNA，治疗后20 - 180天仅在1名患者中持续检测到。
我们的结果表明，通过加强初级卫生保健关注以及在适当外部支持下的广泛社会参与，可以有效解决偏远贫困农村地区克氏锥虫感染的诊断和治疗问题。该战略确保了高治疗覆盖率和依从性；有效管理了ADR，并提供了积极治疗反应的早期证据。
