Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States.
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
entrez:
27
9
2019
pubmed:
27
9
2019
medline:
30
1
2020
Statut:
epublish
Résumé
Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world's most advanced healthcare systems? This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma. We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
Sections du résumé
BACKGROUND
Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world's most advanced healthcare systems?
METHODOLOGY/PRINCIPAL FINDINGS
This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma.
CONCLUSIONS
We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
Identifiants
pubmed: 31557155
doi: 10.1371/journal.pntd.0007447
pii: PNTD-D-18-01514
pmc: PMC6762052
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0007447Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Clinics (Sao Paulo). 2009;64(12):1219-24
pubmed: 20037711
PLoS Negl Trop Dis. 2016 Nov 7;10(11):e0005033
pubmed: 27820837
Expert Rev Anti Infect Ther. 2013 Sep;11(9):957-76
pubmed: 24053276
Clin Infect Dis. 2010 Nov 15;51(10):e69-75
pubmed: 20932171
Am J Trop Med Hyg. 2015 Jul;93(1):108-13
pubmed: 25986581
Comput Struct Biotechnol J. 2016 Dec 14;15:98-103
pubmed: 28066534
Lancet Glob Health. 2017 Apr;5(4):e439-e447
pubmed: 28256340
Am J Trop Med Hyg. 2014 May;90(5):814-818
pubmed: 24808250
Am J Transplant. 2011 Apr;11(4):672-80
pubmed: 21401868
PLoS Negl Trop Dis. 2014 Nov 20;8(11):e3312
pubmed: 25411847
N Engl J Med. 2011 Jun 30;364(26):2527-34
pubmed: 21714649
J Racial Ethn Health Disparities. 2017 Jun;4(3):523-528
pubmed: 27324820
Clin Infect Dis. 2013 Jul;57(1):e7
pubmed: 23537911
Cad Saude Publica. 1999 Apr-Jun;15(2):381-6
pubmed: 10409790
Environ Health Insights. 2014 Dec 10;8(Suppl 2):49-59
pubmed: 25574143
Rev Soc Bras Med Trop. 2007 Jan-Feb;40(1):1-10
pubmed: 17486245
Mem Inst Oswaldo Cruz. 2015 May;110(3):422-32
pubmed: 25946151
Clin Infect Dis. 2009 Sep 1;49(5):e52-4
pubmed: 19640226
Pediatr Infect Dis J. 2018 Jan;37(1):e24-e27
pubmed: 28777208
PLoS Negl Trop Dis. 2017 Aug 18;11(8):e0005770
pubmed: 28820896
Int J Epidemiol. 2013 Aug;42(4):1145-56
pubmed: 23825379
PLoS Med. 2006 Oct;3(10):e449
pubmed: 17076568
Glob Health Promot. 2018 Sep;25(3):102-110
pubmed: 29187039
PLoS Negl Trop Dis. 2013 Sep 12;7(9):e2410
pubmed: 24069473
Lancet. 2002 Jun 22;359(9324):2188-94
pubmed: 12090998
J Parasitol Res. 2012;2012:295034
pubmed: 23326646
Am J Trop Med Hyg. 2010 Oct;83(4):891-5
pubmed: 20889886
Am J Trop Med Hyg. 2017 May;96(5):1139-1142
pubmed: 28500812
Antimicrob Agents Chemother. 2014;58(2):635-9
pubmed: 24247135
Soc Sci Med. 2017 Feb;175:187-198
pubmed: 28107703
Emerg Infect Dis. 2010 May;16(5):871-2
pubmed: 20409389
Am J Trop Med Hyg. 2015 Feb;92(2):325-30
pubmed: 25371187
Circ Heart Fail. 2015 Sep;8(5):938-43
pubmed: 26206855
Am J Trop Med Hyg. 2014 Nov;91(5):915-9
pubmed: 25200261
Clin Infect Dis. 2016 Oct 15;63(8):1056-1062
pubmed: 27432838
PLoS Negl Trop Dis. 2015 Feb 13;9(2):e0003540
pubmed: 25680190
MMWR Morb Mortal Wkly Rep. 2018 Jul 27;67(29):803-805
pubmed: 30048425
PLoS One. 2017 Sep 26;12(9):e0185033
pubmed: 28949997
N Engl J Med. 2014 May 15;370(20):1899-908
pubmed: 24827034
Expert Rev Anti Infect Ther. 2015 Aug;13(8):995-1029
pubmed: 26162928
Rev Esp Cardiol. 2009 Nov;62(11):1224-32
pubmed: 19889333
Wkly Epidemiol Rec. 2015 Feb 6;90(6):33-43
pubmed: 25671846
J Trop Med. 2013;2013:789758
pubmed: 23606862
Gastroenterol Hepatol. 2010 Mar;33(3):191-200
pubmed: 19837482
Lancet Infect Dis. 2018 Apr;18(4):419-430
pubmed: 29352704
Nat Rev Cardiol. 2012 Oct;9(10):576-89
pubmed: 22847166
Clin Infect Dis. 2017 May 1;64(9):1182-1188
pubmed: 28329123
Int Health. 2016 Mar;8 Suppl 1:i53-70
pubmed: 26940310
Am J Trop Med Hyg. 2018 Mar;98(3):735-741
pubmed: 29380723
Med Anthropol. 2018 Apr;37(3):236-252
pubmed: 28759265
Qual Life Res. 2011 Feb;20(1):133-8
pubmed: 21046258
PLoS Negl Trop Dis. 2016 Nov 10;10(11):e0005074
pubmed: 27832063
Risk Manag Healthc Policy. 2015 Oct 30;8:175-83
pubmed: 26586971
Cad Saude Publica. 2009;25 Suppl 1:S71-82
pubmed: 19287869
Int J Parasitol. 2001 May 1;31(5-6):550-4
pubmed: 11334941
Acta Trop. 2016 Apr;156:1-16
pubmed: 26747009
Mem Inst Oswaldo Cruz. 2009 Jul;104 Suppl 1:181-6
pubmed: 19753473
Am J Trop Med Hyg. 2009 Mar;80(3):410-5
pubmed: 19270291
PLoS Negl Trop Dis. 2018 Nov 1;12(11):e0006814
pubmed: 30383777
Trends Parasitol. 2017 Nov;33(11):828-831
pubmed: 28756912
Cad Saude Publica. 2009 Sep;25(9):1947-56
pubmed: 19750382
PLoS Negl Trop Dis. 2013 Oct 17;7(10):e2488
pubmed: 24147169
Euro Surveill. 2011 Sep 15;16(37):null
pubmed: 21944556
N Engl J Med. 2015 Oct;373(14):1295-306
pubmed: 26323937
Am J Trop Med Hyg. 2018 Jun;98(6):1733-1742
pubmed: 29714163
Clin Infect Dis. 2015 Apr 15;60(8):1237-40
pubmed: 25601454
Trop Med Int Health. 2012 May;17(5):595-603
pubmed: 22487303
J Midwifery Womens Health. 2002 Mar-Apr;47(2):80-96
pubmed: 12019990
Am J Trop Med Hyg. 2017 Apr;96(4):805-814
pubmed: 28167589
Rev Soc Bras Med Trop. 2009 Sep-Oct;42(5):484-7
pubmed: 19967227
Health Aff (Millwood). 2009 Jul-Aug;28(4):962-73
pubmed: 19597194
Ann Intern Med. 2006 May 16;144(10):724-34
pubmed: 16702588
Lancet Infect Dis. 2013 Apr;13(4):342-8
pubmed: 23395248
Soc Sci Med. 2012 Mar;74(6):887-93
pubmed: 21684055
J Parasitol. 2010 Apr;96(2):353-8
pubmed: 20001097
J Infect Dis. 1999 Aug;180(2):480-6
pubmed: 10395865
PLoS Negl Trop Dis. 2011 Jan 11;5(1):e931
pubmed: 21264349
Neurol Res. 2010 Apr;32(3):238-44
pubmed: 20406601
J Antimicrob Chemother. 2017 Sep 1;72(9):2596-2601
pubmed: 28645201
Clin Microbiol Rev. 1999 Apr;12(2):210-23
pubmed: 10194457