Implementation research: perspectives of the cuida chagas protocol in strengthening primary health care for chagas disease.
1
1. CUIDA Chagas, Instituto Nacional de Infectologia (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
2
4. CUIDA Chagas, Instituto Nacional de Laboratorios de Salud (INLASA), La Paz, Bolivia
3
2. CUIDA Chagas, Servicio Nacional de Erradicación del Paludismo (SENEPA), Assunción, Paraguay
4
3. CUIDA Chagas, Instituto Nacional de Salud (INS), Bogotá, Colombia
Popul. Med. 2026;8(Supplement Supplement 1):A2278
ABSTRACT
BACKGROUND:
Chagas disease (CD) remains a neglected condition within primary health care (PHC), marked by low detection rates, fragmented care pathways, and missed opportunities for prevention, particularly of congenital transmission.1 Implementation gaps, rather than lack of tools, are central barriers to effective control.2 The cuida chagas project has developed and is applying an implementation protocol designed to integrate CD prevention, diagnosis, treatment, and follow-up into routine PHC services.3
METHODS:
Implementation research is currently conducted across PHC settings in bolivia, brazil, colombia and paraguay. The protocol operationalizes decentralized care through standardized workflows, including screening of women of reproductive age and pregnant women through the use of rapid diagnostic tests (RDTs), confirmatory testing, etiological treatment, follow-up of contacts, and monitoring of newborns and children. Continuous training of health workers, surveillance–care integration, and community engagement are core components. Programmatic data from 2023–2025 were analyzed to assess feasibility and outcomes.
RESULTS:
Approximately 54000 individuals were screened, including 7500 pregnant women (13.9%). Confirmed seropositivity lies between 1.2% and 14.3%, indicating substantial territorial heterogeneity. Among pregnant women, 62 infections were confirmed (0.8%), and 46 babies were evaluated, with three confirmed congenital cases to date. RDTs prove operationally feasible in PHC and enable earlier identification and linkage to care. While diagnostic confirmation and treatment still represent significant barriers, 60% of the confirmed CD patients were treated across the four countries. Education and training activities strengthened workforce capacity, while community engagement increased demand for testing and care.
CONCLUSIONS:
The cuida chagas implementation protocol demonstrates that integrating CD actions into PHC is feasible, effective, and essential for interrupting congenital transmission and expanding access to care. By institutionalizing decentralized workflows, strengthening surveillance–care integration, and prioritizing women of reproductive age, the protocol provides a scalable model to reposition CD within public and maternal and child health policies.
Chagas disease (CD) remains a neglected condition within primary health care (PHC), marked by low detection rates, fragmented care pathways, and missed opportunities for prevention, particularly of congenital transmission.1 Implementation gaps, rather than lack of tools, are central barriers to effective control.2 The cuida chagas project has developed and is applying an implementation protocol designed to integrate CD prevention, diagnosis, treatment, and follow-up into routine PHC services.3
METHODS:
Implementation research is currently conducted across PHC settings in bolivia, brazil, colombia and paraguay. The protocol operationalizes decentralized care through standardized workflows, including screening of women of reproductive age and pregnant women through the use of rapid diagnostic tests (RDTs), confirmatory testing, etiological treatment, follow-up of contacts, and monitoring of newborns and children. Continuous training of health workers, surveillance–care integration, and community engagement are core components. Programmatic data from 2023–2025 were analyzed to assess feasibility and outcomes.
RESULTS:
Approximately 54000 individuals were screened, including 7500 pregnant women (13.9%). Confirmed seropositivity lies between 1.2% and 14.3%, indicating substantial territorial heterogeneity. Among pregnant women, 62 infections were confirmed (0.8%), and 46 babies were evaluated, with three confirmed congenital cases to date. RDTs prove operationally feasible in PHC and enable earlier identification and linkage to care. While diagnostic confirmation and treatment still represent significant barriers, 60% of the confirmed CD patients were treated across the four countries. Education and training activities strengthened workforce capacity, while community engagement increased demand for testing and care.
CONCLUSIONS:
The cuida chagas implementation protocol demonstrates that integrating CD actions into PHC is feasible, effective, and essential for interrupting congenital transmission and expanding access to care. By institutionalizing decentralized workflows, strengthening surveillance–care integration, and prioritizing women of reproductive age, the protocol provides a scalable model to reposition CD within public and maternal and child health policies.
| eISSN: | 2654-1459 |
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