Towards effective coverage of Chagas disease: a community-based approach in migrant populations

BACKGROUND: Community-based approaches have proven effective in improving early access to diagnosis for Chagas disease (CD). This study aimed to assess whether such strategies could reduce the number of patients lost to follow-up and contribute to the detection of concomitant Strongyloides stercoralis infection. METHODS: The intervention was implemented at the Consulate General of Bolivia in Barcelona and began with awareness-raising activities about CD. The Public Health and Community team (eSPiC) subsequently offered on-site serological screening for CD, as well as diagnostic confirmation, antiparasitic treatment, and follow-up at the Drassanes-Vall d'Hebron International Health Unit (USIDVH). RESULTS: Of the 325 participants, 96.3% were adults of Bolivian origin residing in Catalonia, Spain. The mean age was 43 years, and 64.3% were women. Forty-two participants (13.5%) tested positive for CD and received a follow-up appointment. Of these, 22 (52%) attended the consultation; 10 (45.5%) completed antiparasitic treatment; 4 (18.2%) had been previously treated; 2 (9.1%) were not treated due to medical decision; and 6 (27.3%) were lost to follow-up. CONCLUSIONS: This study suggests that community-based follow-up strategies are advisable, particularly among middle-aged women with primary or secondary education. They facilitate a comprehensive continuum of care-from on-site screening to treatment adherence-which is essential for achieving the Chagas disease targets of the World Health Organization's Road Map for Neglected Tropical Diseases by 2030.