RESUMO
Chagas disease (CD) is a neglected tropical disease caused by the parasitic protozoan Trypanosoma cruzi. However, only 20% to 30% of infected individuals will progress to severe symptomatic cardiac manifestations. Current treatments are benznidazole and nifurtimox, which are poorly tolerated regimens. Developing a biomarker to determine the likelihood of patient progression would be helpful for doctors to optimize patient treatment strategies. Such a biomarker would also benefit drug discovery efforts and clinical trials. In this study, we combined untargeted and targeted metabolomics to compare serum samples from T. cruzi-infected individuals who progressed to severe cardiac disease, versus infected individuals who remained at the same disease stage (non-progressors). We identified four unannotated biomarker candidates, which were validated in an independent cohort using both untargeted and targeted analysis techniques. Overall, our findings demonstrate that serum small molecules can predict CD progression, offering potential for clinical monitoring.
RESUMO
Bolivia has one of the highest burdens of Chagas disease in the world. Vertical transmission from mother to infant accounts for a growing number of cases. We performed a systematic review of articles assessing the prevalence of Chagas disease in pregnant women and rates of vertical transmission to infants in Bolivia. Studies were not excluded based on year of publication or language. Random-effects analyses were performed to estimate a pooled prevalence of maternal Chagas disease and pooled vertical transmission rate. Our search yielded 21 articles describing over 400,000 cases of Chagas disease among pregnant women in Bolivia. The reported prevalence of maternal Chagas disease ranged from 17.3% to 64.5%, with a pooled prevalence of 33.0% (95% CI, 27.4-38.7%). The prevalence of maternal Chagas disease trended down over time (P = 0.006), decreasing by approximately 25% to 30% over the last 40 years. Vertical transmission rates ranged from 2.0% to 13% with a pooled average of 6.2% (95% CI, 4.4-7.5%); rates did not significantly change over time. Our study is the first systematic review and meta-analysis of Chagas disease maternal prevalence and vertical transmission in Bolivia. Our findings indicate that maternal Chagas disease has fallen in prevalence but still affects 20% to 30% of pregnant women and poses a considerable risk of vertical transmission. Pregnant women and infants are an important target for public health interventions to limit the mortality and morbidity of Chagas disease and to reduce intergenerational spread.
Assuntos
Doença de Chagas , Transmissão Vertical de Doenças Infecciosas , Humanos , Doença de Chagas/transmissão , Doença de Chagas/epidemiologia , Bolívia/epidemiologia , Feminino , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Gravidez , Prevalência , Complicações Parasitárias na Gravidez/epidemiologia , Recém-NascidoRESUMO
Congenital transmission of Trypanosoma cruzi is an important source of new Chagas infections worldwide. The mechanisms of congenital transmission remain poorly understood, but there is evidence that parasite factors are involved. Investigating changes in parasite strain diversity during transmission could provide insight into the parasite factors that influence the process. Here we use amplicon sequencing of a single copy T. cruzi gene to evaluate the diversity of infection in clinical samples from Chagas positive mothers and their infected infants. Several infants and mothers were infected with multiple parasite strains, mostly of the same TcV lineage, and parasite strain diversity was higher in infants than mothers. Two parasite haplotypes were detected exclusively in infant samples, while one haplotype was never found in infants. Together, these data suggest multiple parasites initiate a congenital infection and that parasite factors influence the probability of vertical transmission.
Assuntos
Doença de Chagas , Parasitos , Trypanosoma cruzi , Feminino , Animais , Humanos , Lactente , Trypanosoma cruzi/genética , Doença de Chagas/congênito , Mães , Transmissão Vertical de Doenças InfecciosasRESUMO
Background: Chagas disease is an endemic protozoan disease with high prevalence in Latin America. Of those infected, 20-30% will develop chronic Chagas cardiomyopathy (CCC) however, prediction using existing clinical criteria remains poor. In this study, we investigated the utility of left ventricular (LV) echocardiographic speckle-tracking global longitudinal strain (GLS) for early detection of CCC. Methods and results: 139 asymptomatic T. cruzi seropositive subjects with normal heart size and normal LV ejection fraction (EF) (stage A or B) were enrolled in this prospective observational study and underwent paired echocardiograms at baseline and 1-year follow-up. Progressors were participants classified as stage C or D at follow-up due to development of symptoms of heart failure, cardiomegaly, or decrease in LVEF. LV GLS was calculated as the average peak systolic strain of 16 LV segments. Measurements were compared between participants who progressed and did not progress by two-sample t-test, and the odds of progression assessed by multivariable logistic regression. Of the 139 participants, 69.8% were female, mean age 55.8 ± 12.5 years, with 12 (8.6%) progressing to Stage C or D at follow-up. Progressors tended to be older, male, with wider QRS duration. LV GLS was -19.0% in progressors vs. -22.4% in non-progressors at baseline, with 71% higher odds of progression per +1% of GLS (adjusted OR 1.71, 95% CI 1.20-2.44, p = 0.003). Conclusion: Baseline LV GLS in participants with CCC stage A or B was predictive of progression within 1-year and may guide timing of clinical follow-up and promote early detection or treatment.
RESUMO
The mechanism of vertical transmission of Trypanosoma cruzi is poorly understood. In this study, we evaluated the role of IgG subclasses in the congenital transmission of Chagas disease. We conducted a case-control study in a public maternity hospital in Santa Cruz, Bolivia, enrolling women at delivery. Thirty women who transmitted T. cruzi to their newborns (cases), and 51 women who did not (controls) were randomly selected from 676 total seropositive women. Trypanosoma cruzi-specific IgG1, IgG2, and IgG3 levels were measured by in-house ELISA. The IgG4 levels were unmeasurable as a result of low levels in all participants. Quantitative polymerase chain reaction results and demographic factors were also analyzed. One-unit increases in normalized absorbance ratio of IgG1 or IgG2 levels increased the odds of congenital T. cruzi transmission in Chagas-seropositive women by 2.0 (95% CI: 1.1-3.6) and 2.27 (95% CI: 0.9-5.7), adjusted for age and previous blood transfusion. Odds of congenital transmission were 7.0 times higher in parasitemic mothers (95% CI: 2.3-21.3, P < 0.01) compared with nonparasitemic mothers. We observed that all mothers with IgG1 ≥ 4 were transmitters (sensitivity = 20%, specificity = 100%). Additionally, no mothers with IgG2 < 1.13 were transmitters (sensitivity = 100%, specificity = 21.6%). We demonstrated that IgG subclasses and parasite presence in blood are associated with vertical transmission of T. cruzi and could identify women at increased risk for congenital transmission by measuring IgG subclasses. These measures have potential as objective screening tests to predict the congenital transmission of Chagas.
Assuntos
Doença de Chagas/diagnóstico , Doença de Chagas/imunologia , Doença de Chagas/transmissão , Imunoglobulina G/sangue , Transmissão Vertical de Doenças Infecciosas , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/imunologia , Trypanosoma cruzi/imunologia , Adulto , Bolívia , Estudos de Casos e Controles , Doença de Chagas/sangue , Feminino , Voluntários Saudáveis , Humanos , Recém-Nascido , Masculino , Gravidez , Fatores de RiscoRESUMO
BACKGROUND: Diagnosis of congenital Chagas disease (CChD) in most endemic areas is based on low-sensitive microscopy at birth and 9-month immunoglobulin G (IgG), which has poor adherence. We aim to evaluate the accuracy of the Immunoglobulin M (IgM)-Shed Acute Phase Antigen (SAPA) test in the diagnosis of CChD at birth. METHODS: Two cohort studies (training and validation cohorts) were conducted in 3 hospitals in the department of Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease, and all infants born to seropositive mothers were followed for up to 9 months to diagnose CChD. A composite reference standard was used to determine congenital infection and was based on the parallel use of microscopy, quantitative polymerase chain reaction (qPCR), and IgM-trypomastigote excreted-secreted antigen (TESA) blot at birth and/or 1 month, and/or the detection of anti-Trypanosoma cruzi IgG at 6 or 9 months. The diagnostic accuracy of the IgM-SAPA test was calculated at birth against the composite reference standard. RESULTS: Adherence to the 6- or 9-month follow-up ranged from 25.3% to 59.7%. Most cases of CChD (training and validation cohort: 76.5% and 83.7%, respectively) were detected during the first month of life using the combination of microscopy, qPCR, and/or IgM-TESA blot. Results from the validation cohort showed that when only 1 infant sample obtained at birth was evaluated, the qPCR and the IgM-SAPA test have similar accuracy (sensitivity: range, 79.1%-97.1% and 76.7%-94.3%, respectively, and specificity: 99.5% and 92.6%, respectively). CONCLUSIONS: The IgM-SAPA test has the potential to be implemented as an early diagnostic tool in areas that currently rely only on microscopy.
Assuntos
Doença de Chagas , Trypanosoma cruzi , Anticorpos Antiprotozoários , Bolívia , Doença de Chagas/diagnóstico , Diagnóstico Precoce , Feminino , Objetivos , Humanos , Imunoglobulina M , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , GravidezRESUMO
BACKGROUND: Vertical transmission of Trypanosoma cruzi infection accounts for a growing proportion of new cases of Chagas disease. Better risk stratification is needed to predict which women are more likely to transmit the infection. METHODS: This study enrolled women and their infants at the Percy Boland Women's Hospital in Santa Cruz, Bolivia. Pregnant women were screened for Chagas disease by rapid test and received confirmatory serology. Infants of seropositive mothers underwent diagnostic testing with quantitative polymerase chain reaction (qPCR). RESULTS: Among 5828 enrolled women, 1271 (21.8%) screened positive for Chagas disease. Older maternal age, family history of Chagas disease, home conditions, lower educational level, and history of living in a rural area were significantly associated with higher adjusted odds of maternal infection. Of the 1325 infants of seropositive mothers, 65 infants (4.9%) were diagnosed with congenital Chagas disease. Protective factors against transmission included cesarean delivery (adjusted odds ratio [aOR]: .60; 95% confidence interval [CI]: .36-.99) and family history of Chagas disease (aOR: .58; 95% CI: .34-.99). Twins were significantly more likely to be congenitally infected than singleton births (OR: 3.32; 95% CI: 1.60-6.90). Among congenitally infected infants, 32.3% had low birth weight, and 30.8% required hospitalization after birth. CONCLUSIONS: Although improved access to screening and qPCR increased the number of infants diagnosed with congenital Chagas disease, many infants remain undiagnosed. A better understanding of risk factors and improved access to highly sensitive and specific diagnostic techniques for congenital Chagas disease may help improve regional initiatives to reduce disease burden.
Assuntos
Doença de Chagas , Trypanosoma cruzi , Bolívia/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Feminino , Hospitais , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Mães , Gravidez , Fatores de RiscoRESUMO
Capacity building in public health is an urgent global priority. Recently, there has been an increasing emphasis on South-South and triangular cooperation. We describe our experience with a public health training collaboration between Peru and Bolivia, with Peru providing capacity building and expertise to Bolivia, while receiving supportive funding and training from the United States. This collaboration has led to a groundswell of research on clinically significant diseases, outreach to more than 800 scientists, several dozen publications, and the start of four institutional review boards. South-South and South-South-North collaborations should publish their experiences, and Northern funding organizations should consider funding such collaborations.
Assuntos
Fortalecimento Institucional , Acessibilidade aos Serviços de Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Saúde Pública/educação , Bolívia , Países em Desenvolvimento , Humanos , Cooperação Internacional , Peru , Estados UnidosRESUMO
We generated nine coding-complete chikungunya virus genome sequences from blood samples collected during the early 2015 outbreak in Bolivia. Relative to other publicly available chikungunya sequences, the Bolivian samples represent a monophyletic group, suggesting that a single lineage was widely circulating in the country between February and May 2015.
RESUMO
BACKGROUND: The detection of Trypanosoma cruzi genetic material in clinical samples is considered an important diagnostic tool for Chagas disease. We have previously demonstrated that PCR using clot samples yields greater sensitivity than either buffy coat or whole blood samples. However, phenol-chloroform DNA extraction from clot samples is difficult and toxic. The objective of the present study was to improve and develop a more sensitive method to recover parasite DNA from clot samples for the diagnosis of Chagas disease. METHODOLOGY/PRINCIPAL FINDINGS: A total of 265 match pair samples of whole blood-guanidine (GEB) and clot samples were analyzed; 150 were from Chagas seropositive subjects. DNA was extracted from both whole blood-guanidine samples, using a previously standardized methodology, and from clot samples, using a newly developed methodology based on a combination of the FastPrep technique and the standard method for GEB extraction. A qPCR targeting the nuclear satellite sequences was used to compare the sample source and the extraction method. Of the 150 samples from Chagas positive individuals by serology, 47 samples tested positive by qPCR with DNA extracted by both GEB and clot, but an additional 13 samples tested positive only in DNA extracted from clot. No serology-negative samples resulted positive when tested by qPCR. CONCLUSIONS: The new methodology for DNA extraction from clot samples improves the molecular diagnosis of Chagas disease.
Assuntos
Doença de Chagas/diagnóstico , DNA de Protozoário/sangue , Trypanosoma cruzi/genética , Doença de Chagas/parasitologia , DNA de Protozoário/genética , Testes Diagnósticos de Rotina/métodos , Humanos , Técnicas de Diagnóstico Molecular , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sensibilidade e Especificidade , Testes Sorológicos/métodos , Trypanosoma cruzi/isolamento & purificaçãoRESUMO
Background: Congenital Trypanosoma cruzi infection accounts for an estimated 22% of new cases of Chagas disease in Latin America. However, neonatal diagnosis is challenging, as 9-month follow-up for immunoglobulin G testing is poor, quantitative polymerase chain reaction (qPCR) analysis is not routinely performed, and the micromethod misses ≥40% of congenital infections. Methods: Biorepository samples from new mothers and their infants from Piura, Peru, (an area of nonendemicity), and Santa Cruz, Bolivia (an area of endemicity) were accessed. Infant specimens were assessed using the micromethod, qPCR analysis, and a trypomastigote excretory secretory antigen (TESA) blot for detection of immunoglobulin M (IgM)-specific shed acute phase antigen (SAPA) bands, using qPCR as the gold standard. Results: When compared to qPCR, IgM TESA blot was both sensitive and specific for congenital Chagas disease diagnosis. Cumulative sensitivity (whether only 4 bands or all 6 bands were present) was 80% (95% confidence interval [CI], 59%-92%). Specificity was 94% (95% CI, 92%-96%) in the area of endemicity and 100% in the area of nonendemicity. SAPA bands occurred sequentially and in pairs, and parasite loads correlated highly with the number of SAPA bands present. The micromethod detected infection in fewer than half of infected infants. Conclusions: The IgM TESA blot for detection of SAPA bands is rapid, relatively inexpensive, and more sensitive than the micromethod and may be a useful point-of-care test for detection of congenital T. cruzi infection.
Assuntos
Doença de Chagas/congênito , Doença de Chagas/diagnóstico , Testes Diagnósticos de Rotina/métodos , Glicoproteínas/sangue , Immunoblotting/métodos , Imunoglobulina M/imunologia , Neuraminidase/sangue , Trypanosoma cruzi/imunologia , Anticorpos Antiprotozoários/imunologia , Bolívia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Peru , Gravidez , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Identify health-worker barriers that keep pregnant women who receive prenatal care from being screened for syphilis (Los Andes Health Network, Bolivia). METHODS: Semi-structured interviews were done with 46 health care providers and 249 clinical health records of pregnant women were analyzed in eight public health facilities in the Los Andes network. RESULTS: Health-worker barriers to syphilis screening in pregnant women included lack of time by personnel to raise awareness of the benefit of syphilis screening; some mentioned that syphilis tests should only be done in facilities that attend deliveries and have a laboratory; lack of communication between clinicians and laboratory personnel; and problems with provision of supplies and reagents. The clinical record review found that only 55.4% contained syphilis laboratory results and only 37.4% of perinatal clinical histories had records of laboratory results. The interviews found that providers believe that syphilis screening is done in 100% of pregnant women receiving prenatal care. CONCLUSION: Syphilis screening is not being done according to Bolivia's strategy for the elimination of congenital syphilis, and is not done on more than half of pregnant women in prenatal care with perinatal clinical history records. This is not perceived by health professionals and can become a barrier to syphilis screening in pregnant women.
Assuntos
Acessibilidade aos Serviços de Saúde , Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Bolívia , Feminino , Humanos , GravidezRESUMO
RESUMEN Objetivo Identificar barreras del personal de salud por las cuales las embarazadas que asisten al control prenatal no se realizan el tamizaje de sífilis (Red de Salud Los Andes, Bolivia). Métodos Se realizaron 46 entrevistas semiestructuradas a proveedores de salud y se analizaron los registros de 249 expedientes clínicos de embarazadas de ocho establecimientos públicos de salud de la Red Los Andes. Resultados Entre las barreras del personal de salud para el tamizaje de sífilis en embarazadas se identificaron el tiempo insuficiente del personal para sensibilizar sobre el beneficio del tamizaje de sífilis, algunos mencionaron que las pruebas de sífilis se deberían hacer solo en centros donde atienden partos y tienen laboratorio, la poca comunicación entre el personal de la consulta médica y laboratorio, así como también problemas de abastecimiento de suministros y reactivos. En la revisión de expedientes clínicos se observó que 55,4% contaba con los resultados de laboratorio de sífilis en sus expedientes y solo 37,4% de historias clínicas perinatales contaba con registro de resultados de laboratorios. A través de las entrevistas, se pudo observar que los proveedores perciben que el tamizaje de sífilis se realiza al 100% de las embarazadas que asisten al control prenatal. Conclusión El tamizaje para sífilis no se está realizando según lo establecido en la estrategia de país para la eliminación de la sífilis congénita, y no llega a más de la mitad de embarazadas en control prenatal con registros en las historias clínicas perinatales. Esto no es percibido por los profesionales de la salud y puede transformarse en una barrera para el tamizaje de sífilis en mujeres embarazadas.
ABSTRACT Objective Identify health-worker barriers that keep pregnant women who receive prenatal care from being screened for syphilis (Los Andes Health Network, Bolivia). Methods Semi-structured interviews were done with 46 health care providers and 249 clinical health records of pregnant women were analyzed in eight public health facilities in the Los Andes network. Results Health-worker barriers to syphilis screening in pregnant women included lack of time by personnel to raise awareness of the benefit of syphilis screening; some mentioned that syphilis tests should only be done in facilities that attend deliveries and have a laboratory; lack of communication between clinicians and laboratory personnel; and problems with provision of supplies and reagents. The clinical record review found that only 55.4% contained syphilis laboratory results and only 37.4% of perinatal clinical histories had records of laboratory results. The interviews found that providers believe that syphilis screening is done in 100% of pregnant women receiving prenatal care. Conclusion Syphilis screening is not being done according to Bolivia’s strategy for the elimination of congenital syphilis, and is not done on more than half of pregnant women in prenatal care with perinatal clinical history records. This is not perceived by health professionals and can become a barrier to syphilis screening in pregnant women.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Sífilis/diagnóstico , Acessibilidade aos Serviços de Saúde , BolíviaRESUMO
We examined data from a clinic-based survey of 1,222 Bolivian female sex workers (FSWs) to assess whether use of nonbarrier modern contraception is associated with less consistent condom use with clients and noncommercial partners. Women who were using nonbarrier modern contraception were less likely than nonusers to consistently use condoms with noncommercial partners (AOR 0.393, 95% CI 0.203-0.759, p = .005). With clients, this inverse association did not hold. Public health professionals must consider both disease prevention and pregnancy prevention needs in this vulnerable population, and messages should be tailored to encourage dual method use with all partners.
Assuntos
Preservativos/estatística & dados numéricos , Comportamento Contraceptivo , Anticoncepcionais Femininos , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Profissionais do Sexo/psicologia , Adolescente , Adulto , Bolívia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Gravidez , Gravidez não Desejada , Comportamento de Redução do Risco , Sexo Seguro/estatística & dados numéricos , Trabalho Sexual/psicologia , Parceiros Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana , Adulto JovemRESUMO
OBJECTIVE: Assess the feasibility and acceptability of a patient-led syphilis partner notification strategy among pregnant women with syphilis, their male partners and treatment completion in Bolivia. METHODS: In four provinces, women who had tested positive for syphilis while attending antenatal care visits were recruited to receive a partner notification (PN) intervention on how to notify partners of their positive diagnosis and encourage them to get tested/treated. All women who completed PN counselling and notified their male partners completed self-administered questionnaires regarding PN experiences. Sociodemographic characteristics associated with notification and partner treatment completion were assessed using bivariate and multivariate analyses. RESULTS: 144 women and 137 male partners participated; 78% women notified their partners. No women characteristics were significantly associated with PN. Significantly more male partners (85%) who were notified by women completed syphilis treatment (p<0.05) compared to those notified by providers (66%). In multivariate analysis, men notified by female partners had a threefold greater odds of treatment completion compared to men who had not been notified by partners or by someone else (ie, healthcare worker) (OR 3.45, 95% CI 1.21 to 9.90). 86% of women and 80% of men completed syphilis treatment. Our results suggest that lack of time was considered a barrier to care among men who did not complete treatment. CONCLUSION: A patient-led partner notification strategy for pregnant women and their male partners appears to be feasible and acceptable, providing evidence for larger-scale effectiveness studies to improve male partner treatment compliance.
Assuntos
Busca de Comunicante/métodos , Complicações Infecciosas na Gravidez , Sífilis/prevenção & controle , Adulto , Bolívia , Escolaridade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Cooperação do Paciente , Participação do Paciente , Satisfação do Paciente , Gravidez , Cuidado Pré-Natal/métodos , Sífilis/transmissão , Adulto JovemRESUMO
OBJETIVO: Calcular las frecuencias de sífilis materna y congénita, transmisión del agente etiológico de la madre al recién nacido, y variables asociadas con la enfermedad, en seis hospitales públicos en Bolivia. MATERIAL Y MÉTODOS: Se realizó un estudio transversal de mayo a septiembre de 2004. Se administró la prueba rápida para sífilis Determine-TP y RPR cuantitativo a mujeres postparto sin RPR previo. Se incluyeron antecedentes demográficos y de atención prenatal de embarazos previos. A los recién nacidos de madres con sífilis se les practicó Western Blot IgM p47 y ELISA IgM. Las pruebas serológicas se procesaron en el Laboratorio Nacional de Referencia (INLASA). Se realizó un análisis estadístico bivariado y multivariado para establecer asociaciones con el diagnóstico positivo a T. pallidum. RESULTADOS: La prevalencia de sífilis entre 1 594 mujeres postparto fue de 7.2 por ciento, con una proporción de transmisión de infección de madres a recién nacidos de 15.7 por ciento. La prevalencia de sífilis congénita por serología fue de 1.1 por ciento; 94 por ciento de estos neonatos no presentaron sintomatología. A pesar de una cobertura de control prenatal de 70.5 por ciento en Bolivia, aún existen mujeres que acuden directamente al parto institucional sin contar con tamizaje previo para sífilis con pruebas de rutina. El bajo nivel de instrucción formal (< 8 años) en ambos padres y no asistir a control prenatal se asociaron con sífilis congénita. CONCLUSIONES: Es importante fortalecer las estrategias de diagnóstico temprano de sífilis durante el embarazo, utilizando pruebas rápidas para contribuir a la prevención de la sífilis congénita y materna.
OBJECTIVE: Assess frequencies of maternal and congenital syphilis, mother-child transmission and variables associated with syphilis in six urban hospitals in Bolivia. MATERIAL AND METHODS: A cross-sectional study was performed between May and September 2004. We administered the Abbot Determine-TP rapid test and quantitative RPR to postpartum women without prior RPR. Sociodemographic variables and prior prenatal care visits were studied. Newborns of syphilis positive mothers were studied with Western Blot IgM p47 and ELISA IgM. Serum samples were analyzed at the Central Reference Laboratory (INLASA). Statistical analysis included bivariate and multivariate analyses to establish association with positive diagnosis of T. pallidum. RESULTS: Syphilis prevalence among 1 594 postpartum women was 7.2 percent. Mother to child transmission was 15.7 percent. Congenital syphilis prevalence by serology was 1.1 percent and 94 percent of these newborns displayed no symptoms. Despite 70.5 percent prenatal care coverage in Bolivia some women still go directly to a facility to give birth without prior routine tests for syphilis. Low education levels in both parents (< 8 years) and failure to attend prenatal care were strong predictors of congenital syphilis. CONCLUSIONS: Rapid syphilis tests constitute an important tool to strengthen early diagnosis of syphilis during pregnancy. Preventing congenital and maternal syphilis in Bolivia remains a public health priority.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Sífilis/epidemiologia , Bolívia/epidemiologia , Estudos Transversais , Hospitais Urbanos/estatística & dados numéricos , Período Pós-Parto , Cuidado Pré-Natal , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Sorodiagnóstico da Sífilis/estatística & dados numéricos , Sorodiagnóstico da Sífilis , Sífilis Congênita , População UrbanaRESUMO
OBJECTIVES: Use a gender perspective to analyze a partner notification study conducted in antenatal clinics in Bolivia to assess the association between intimate partner violence (IPV) and partner notification. GOAL: Guide the implementation of a safe, feasible, and culturally appropriate partner notification strategy in Bolivia in order to reduce the potential of IPV. STUDY DESIGN: We conducted a cross-sectional survey with women (n = 209) and their notified partners (n = 137) and structured interviews with a subsample of participants. RESULTS: Nearly 40% of women reported IPV in the past year and 28% mentioned fear of violence as a barrier to notifying their partners. Overall, 65% of women reported that they had notified their partners about their positive syphilis test results. Women who did not perceive violence as a barrier had greater odds of notifying their partner of their syphilis status (OR = 1.82; CI [0.93-3.60]; P <0.08). Women who could not protect themselves against partners' syphilis had a lower odds of notifying their partner (OR = 0.06; CI [0.049-0.656]; P <0.0001). Women who notified their partners said it was a favorable experience. Most men said they responded well to their partner's disclosure but could understand other men acting violently, especially when infidelity was involved. CONCLUSIONS: The majority of women who participated were able to notify male partners of their positive syphilis diagnosis but also reported high levels of domestic violence. The data suggest that public health practitioners should concomitantly screen for IPV and syphilis during pregnancy and assist women in abusive relationships on how to communicate sensitive disclosure information to partners.
Assuntos
Busca de Comunicante , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Maus-Tratos Conjugais , Sífilis/epidemiologia , Sífilis/prevenção & controle , Adolescente , Adulto , Bolívia/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Entrevistas como Assunto , Masculino , Programas de Rastreamento/métodos , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Sífilis/etiologia , Sífilis/transmissão , Sífilis Congênita/prevenção & controleRESUMO
OBJECTIVE: The objective of this study was to compare the costs of antenatal syphilis screening with the rapid plasma reagin (RPR) test and the immunochromatographic strip (ICS) test in low-resource settings. GOAL: The goal of this study was to assess the costs of introducing rapid syphilis tests to reduce maternal and congenital syphilis. STUDY DESIGN: Cost data were collected from participating study hospitals and antenatal clinics during 4 field visits to the 2 countries in 2003 and 2004. Health utilization outcome data on the number of women screened and treated routinely during the demonstration projects were used with unit cost data to estimate the incremental costs and average cost per woman screened and treated for maternal syphilis. RESULTS: In Mozambique, the average cost per woman screened was U.S. $0.91 and U.S. $1.05 for the RPR and ICS tests, respectively. In Bolivia, the average cost of screening was U.S. $1.48 and U.S. $1.91 using the RPR and ICS test, respectively. In health centers without laboratories, the cost per woman screened using the ICS test ranged from U.S. $1.02 in Mozambique to U.S. $2.84 in Bolivia. CONCLUSIONS: It is feasible to introduce rapid syphilis testing in settings without laboratory services at a small incremental cost per woman screened. In settings with laboratories, the cost of ICS is similar to that of RPR.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/economia , Diagnóstico Pré-Natal/estatística & dados numéricos , Sífilis/diagnóstico , Instituições de Assistência Ambulatorial , Bolívia/epidemiologia , Cromatografia/economia , Cromatografia/métodos , Custos e Análise de Custo , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais , Humanos , Imunoensaio/economia , Imunoensaio/métodos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Moçambique/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Kit de Reagentes para Diagnóstico/economia , Kit de Reagentes para Diagnóstico/estatística & dados numéricos , Reaginas/sangue , Sífilis/epidemiologia , Sífilis/prevenção & controle , Sífilis/transmissão , Sífilis Congênita/prevenção & controleRESUMO
OBJECTIVES: We introduced syphilis immunochromatic strip (ICS) tests into antenatal care (ANC) settings in Bolivia and evaluated feasibility, patient and provider acceptability, and introduction costs. We conducted complementary studies on related topics, strengthened quality of care, and aided the response to sensitive aspects of maternal/congenital syphilis control (e.g., partner notification). GOAL: The goal of this study was to discuss our experience working with Bolivian stakeholders to document potential public health benefits of syphilis ICS test introduction in ANC settings. STUDY DESIGN: We trained public health personnel and offered the Abbott Determine Rapid Syphilis TP test in 4 urban maternity hospitals and 37 rural clinics. RESULTS: Using the ICS test, 11,618 women were tested for syphilis; 5% had positive results and 93.2% received treatment. Women and health personnel found the test acceptable and introduction costs were not prohibitive. CONCLUSIONS: Based on these findings, by mid-2006, the Bolivian Ministry of Health will offer the ICS tests in rural ANC settings.
Assuntos
Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Sífilis/diagnóstico , Adulto , Bolívia/epidemiologia , Cromatografia/métodos , Custos e Análise de Custo , Feminino , Humanos , Imunoensaio , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Kit de Reagentes para Diagnóstico/economia , Kit de Reagentes para Diagnóstico/estatística & dados numéricos , Saúde da População Rural , Sífilis/epidemiologia , Sífilis/prevenção & controle , Sífilis/transmissão , Sífilis Congênita/prevenção & controleRESUMO
OBJECTIVE: Assess frequencies of maternal and congenital syphilis, mother-child transmission and variables associated with syphilis in six urban hospitals in Bolivia. MATERIAL AND METHODS: A cross-sectional study was performed between May and September 2004. We administered the Abbot Determine-TP rapid test and quantitative RPR to postpartum women without prior RPR. Sociodemographic variables and prior prenatal care visits were studied. Newborns of syphilis positive mothers were studied with Western Blot IgM p47 and ELISA IgM. Serum samples were analyzed at the Central Reference Laboratory (INLASA). Statistical analysis included bivariate and multivariate analyses to establish association with positive diagnosis of T. pallidum. RESULTS: Syphilis prevalence among 1 594 postpartum women was 7.2%. Mother to child transmission was 15.7%. Congenital syphilis prevalence by serology was 1.1% and 94% of these newborns displayed no symptoms. Despite 70.5% prenatal care coverage in Bolivia some women still go directly to a facility to give birth without prior routine tests for syphilis. Low education levels in both parents (< 8 years) and failure to attend prenatal care were strong predictors of congenital syphilis. CONCLUSIONS: Rapid syphilis tests constitute an important tool to strengthen early diagnosis of syphilis during pregnancy. Preventing congenital and maternal syphilis in Bolivia remains a public health priority.