An Evidence-Based Intervention to Increase Trypanosoma cruzi, a Neglected Parasitic Infection, Diagnosis in Rural and Moderate-Size-City US Clinics

Abstract

Background Chagas disease is a chronic, insidious parasitic infection (Trypanosoma cruzi) that slowly develops to irreversible organomegaly over several decades. The disease is traditionally acquired in endemic Latin American countries during childhood; <1% of foreign-born adult residents in the United States have been diagnosed or treated with this potentially fatal disease. Low physician knowledge is a primary factor leading to misdiagnosis. Methods Starting in April 2022, a 4-part T cruzi clinical education intervention began, which included (i) 2 grand rounds presentations to >100 internal medicine providers; (ii) implementation of a "clinical Chagas champions program"incorporating 14 key clinical staff at varying departments and administrative levels educated on their specific role related to T cruzi screening, diagnosis confirmation, clinical management, and medical billing; (iii) connecting clinicians with external, experienced providers to provide guidance during the medically challenging treatment process; and (iv) T cruzi patient screening at Prisma Health hospitals, family medicine clinics, or affiliated free health clinics. The program's long-term impact was evaluated using a panel Poisson time series statistical model of ordered tests pre- and post-intervention. Results For the healthcare system screening initiative, 71 participants were enrolled from across Prisma Health's 21-county region, with a 2.9% Chagas disease seroprevalence detected. Time series analysis of T cruzi testing orders within the healthcare system demonstrated a statistically significant increase in ordered tests across the 30 months post-intervention compared to the 51 months prior. Conclusions This intervention substantiates the need to pair academic-health partnerships and clinical awareness campaigns to sustainably support long-term T cruzi screening in nontraditional areas.