Results and evaluation of the expansion of a model of comprehensive care for Chagas disease within the National Health System: The Bolivian Chagas network.

BACKGROUND: Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world. METHODS: With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program. RESULTS: The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area). CONCLUSIONS: After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries.

Community-based entomological surveillance in three Chagas disease-endemic regions in sub-Andean Bolivia.

BACKGROUND: Chagas disease is endemic throughout most of Bolivia, with prevalence rates of 25% observed in some geographic areas located mainly in the sub-Andean region. METHODS: Community-based entomological surveillance was carried out in the sub-Andean departments of Cochabamba (municipalities of Cochabamba, Punata and Sacaba), Tarija (municipality of Tarija) and Chuquisaca (municipality of Sucre). The surveillance parameters evaluated were: (i) the proportion of cards with the presence of triatomines; (ii) the distribution of positive cards by area; and (iii) the proportion of cards with the presence of infected triatomines. RESULTS: Of the cards returned, in 852 (3.1%) there was a mention of the presence of triatomines. The species Triatoma infestans, Triatoma sordida and Triatoma guasayana were identified in 812 (95.3%), 39 (4.6%) and 1 (0.1%), respectively. The median monthly positivity rate of the cards during 2011-2018 was higher in Punata (9.1%; IQR=3.2-15.4%). The median monthly rate was highest in 2012 (2.7%; IQR=0-5.6%). Fifty positive cards (5.8%) presented insects that were positive for trypanosomatids, mainly in Cochabamba and Punata. CONCLUSIONS: The report of triatomines foci by inhabitants represents an effective surveillance system coordinated by a network of specialized and multidisciplinary health centers. These strategies, which should be included in the health policies of endemic countries, enable extending and deepening the dialogue among technicians, communities and their local authorities.

Caracterización de la infestación de viviendas por Aedes aegypti en el área metropolitana de Cochabamba, Bolivia: nuevos registros altitudinales / Characterization of dwellings' infestation by Aedes aegypti in the metropolitan area of Cochabamba, Bolivia: new altitudinal records

La rápida proliferación del vector en áreas de clima cálido y baja altitud, como el oriente y la amazonia boliviana, generó la necesidad de analizar la adaptabilidad del A. aegypti en zonas templadas, tal es el caso de los valles mesotérmicos de la ciudad metropolitana de Cochabamba. La evaluación entomológica se realizó en una muestra de 264 viviendas seleccionadas al azar en Abril del 2016. El área de estudio abarca zonas urbanas de seis municipios (Cercado, Sacaba, Colcapirhua, Tiquipaya, Quillacollo y Vinto) del departamento de Cochabamba. El diseño para el estudio fue epidemiológico, transversal de diagnóstico comunitario. De la muestra referida, 100 viviendas se encontraron larvas de A. aegypti , que corresponde a un 38% de infestación larvaria y un Índice Breteau de 1,0. Las llantas, turriles y recipientes desechables son un factor de riesgo para la propagación y adaptación del vector en nuestra región. Los hallazgos confirman la dispersión del A. aegypti con algunas regiones con mayor prevalencia (zona sud de cercado urbano, Colcapirhua y Quillacollo en el valle bajo). También se evidenció por primera vez que la dispersión y colonización de larvas de A. aegypti en el área de estudio alcanzó una altura mínima de 2 538 m/s/n/m. y una altura máxima de 2 623 m.s.n.m. La prevención y el control de A. aegypti , en la metrópoli de Cochabamba va a requerir un trabajo mancomunado integral e intersectorial enfocados en una estrategia de intervención de gestión socioambiental de corresponsabilidad y participación comunitaria, generando como resultado un Manejo Integrado del Vector.

The fast proliferation of the vector at warm weather and low altitude over the sea level, such as the Bolivian valleys (as Cochabamba city), generates the need to analyze the adaptability of A. aegypti . This study of comunitary diagnosis, was developed at the metropolitan area of Cochabamba city, it confirms an spread A. aegypti , shown by georeferences of identified focus of high prevalence (sud of the city, Colcapirhua and Quillacollo as a low valley). For the first time this vector spread, reached between 2 538 to 2 623 meters over sea level. From 264 inspected houses over the city, 100 cases were found positive for A. aegypti (38%) (Breteau Index: 1,0). According to the study, tires, barrels and small containers are a risk factor for the spread and adaptation of the vector in our region. Prevention and control of A. aegypti in the metropolis of Cochabamba will require an integrated and intersectoral joint work, focused on a strategy of intervention socio-environmental and community participation, generating results in an Integrated Vector Management.

Trypanosoma cruzi-infected Panstrongylus geniculatus and Rhodnius robustus adults invade households in the Tropics of Cochabamba region of Bolivia.

BACKGROUND: There are hardly any data available on the relationships between the parasite and the vector or regarding potential reservoirs involved in the natural transmission cycle of Trypanosoma cruzi in the Tropics of Cochabamba, Bolivia. Local families from communities were responsible for the capture of triatomine specimens, following a strategic methodology based on entomological surveillance with community participation developed by the National Chagas Programme of the Ministry of Health of Bolivia. FINDINGS: We describe the collection of adult Panstrongylus geniculatus and Rhodnius robustus naturally infected with Trypanosoma cruzi from houses and from the hospital of Villa Tunari municipality. The flagellates found in the digestive tract of P. geniculatus belong to genetic lineages or DTUs TcI and TcIII, whereas only lineage DTU TcI was found in R. robustus. The detection of these vectors infected with T. cruzi reveals the vulnerability of local communities. CONCLUSION: The results presented here highlight the risk of Chagas disease transmission in a region previously thought not to be endemic, indicating that the Tropics of Cochabamba should be placed under permanent entomological and epidemiological surveillance.

Consolidar la documentación con miras a considerar la certificación de la interrupción de la transmisión de chagas en los departamentos de La Paz y Cochabamba / ss

La enfermedad de chagas presenta un serio problema de salud pública tanto por su magnitud, transcendencia,impacto y dficíl control. El área conocida de disperción del principal vector (Triatoma infestans) de la enfermedad de chagas en Bolivia cubre aproximadamente el 60 por ciento del territorio

Biología reproductiva de dos poblaciones de Triatoma infestans (Hemiptera: Reduviidae) en condiciones de laboratorio / Reproductive biology of two populations of Triatoma infestans (Hemiptera: Reduviidae) under laboratory conditions

Objetivos: en el presente estudio, se documentó la biología reproductiva de dos poblaciones de T. infestans provenientes de los Valles Mesotérmicos Andinos (20 de Octubre) y del Chaco Serrano (Mataral), en condiciones de laboratorio. Métodos: se utilizaron 15 parejas de T. infestans por población (Mataral y 20 de Octubre) y como población control colonias de T. infestans de laboratorio; siendo alimentados en gallinas durante 45 minutos y mantenidos en una cámara climática a 28±3°C, 60±5%. Se calcularon los siguientes parámetros e índices: Fecundidad, Fertilidad, Índice de Ovipostura (IO), Índice de Fertilidad (IF). Resultados: se observó que las cepa de T. infestans de la localidad 20 de Octubre, presentaron mayor número de huevos; fecundidad promedio por día de (1.95±1.5), una fertilidad de 95.6%, (IO) promedio fue de 0.43 y (IF) promedio de 0.9. Análisis estadísticos indicaron que la localidad 20 de Octubre presentó valores significativos entre variables de número de huevos y peso de los triatominos con una relación de R2=0,77 y una correlación de Pearson (p=0,0008). Conclusiones: en condiciones de laboratorio poblaciones diferentes de T. infestans de diferentes regiones de Bolivia presentan patrones de Fecundidad y Fertilidad diferentes; estos datos son de suma importancia para ser considerados por los Programas de Control Vectorial ya que el ciclo biológico de una misma especie vectora puede variar en función al área geográfica, por lo cual es muy importante continuar con estudios que describan y ayuden a comprender la biología de las principales especies vectores en Bolivia.

Objectives: in the present study, we documented the reproductive biology of two populations of T. infestans, from the mesothermic Andean Valleys (20 de Octubre) and the Chaco Serrano (Mataral) in laboratory conditions. Methods: there was used 15 pairs of T. infestans populations (Mataral and 20 de Octubre). The control population was colonies of T. infestans from laboratory. The insects were fed on chickens for 45 minutes and kept in a climate chamber at 28 ± 3 ° C, 60 ± 5%. The following parameters and rates were calculated: Fecundity, Fertility, oviposition index (IO), fertility index (FI). Results: it was observed that the T. infestans strain from 20 de Octubre locality, presented the greatest number of eggs per day, with a daily fecundity average rate of (1.95 ± 1.5), a fertility of 95.6% (IO) averaged 0.43 (IF) average of 0.9. Statistical analysis shown that the 20 de octubre locality, presented significant values between variables of number of eggs and the weight of triatomines with a ratio of R2 = 0.77 and a significant Pearson correlation. Conclusions: under laboratory conditions two different populations of T. infestans coming from different regions of Bolivia, shown different patterns of fecundity and fertility, these data are of valuable importance to be considered by vector control programs, since showed that the life cycle of the same vector species may vary according to geographical area, therefore, is very important to continue with studies that describe and help to understand the biology of the main vector species in Bolivia.

Triatominos de Bolivia y la enfermedad de Chagas / Triatomines from Bolivia and Chagas disease

El presente documento técnico científico pretende fortalecer el conocimiento para tomar acciones epidemiológicas en las zonas endémicas donde el ser humano convive con el parásito de Trypanosoma cruzi y la vinchuca, cuyas zonas se muestran con mayor incidencia en la enfermedad de Chagas que sigue castigando nuestro país y las poblaciones de América.