03220nas a2200457 4500000000100000008004100001260001600042653002000058653003900078653002300117653002700140653001100167100002300178700001400201700001600215700002700231700002100258700002400279700002600303700001500329700001500344700001900359700001600378700001500394700001700409700001500426700001400441700001200455700001300467700002800480700003100508700001500539700002100554700001400575245020600589856008700795300000700882490000700889520185200896022001402748 2025 d bElsevier BV10aChagas' disease10aNeglected tropical diseases (NTDs)10aPrimary healthcare10aImplementation science10aBrazil1 aValente Moreira CH1 aAzevedo L1 aFerreira AM1 aGonçalves Oliveira AC1 aBrito de Souza A1 aSant’Ana Haikal D1 aDi Lorenzo Oliveira C1 aCardoso CS1 aSpinelli M1 aBierrenbach AL1 aQuintino ND1 aBaldoni NR1 aDamasceno RF1 aDrumond MR1 aVieira TM1 aCruz DS1 aLeite SF1 aClara de Jesus Santos A1 aCampos de Oliveira Silva L1 aBuccheri R1 aPinho Ribeiro AL1 aSabino EC00aBridging the gap in Chagas disease management: a mixed-methods study using an implementation science approach within the Brazilian primary health care system—‘Implementa-Chagas/SaMi-Trop project’ uhttps://www.thelancet.com/journals/lanam/article/PIIS2667-193X(25)00146-2/fulltext a120 v473 a

Background

Chagas Disease (ChD), a prevalent Neglected Tropical Disease in Latin America, affects millions and poses significant challenges in Brazil's primary healthcare system. Despite the availability of diagnostic tools and effective drugs, screening and treatment rates remain alarmingly low. This study aims to identify barriers and facilitators in ChD management, focusing on integrating services into routine healthcare operations.

Methods

An exploratory sequential mixed-methods approach was used, combining focus groups with primary care physicians, in-depth interviews, and quantitative surveys with healthcare professionals. The Theoretical Domains Framework (TDF) and the Capability Opportunity Motivation-Behaviour (COM-B) model guided the analysis of decision-making processes in ChD management. Intervention strategies were developed using the Behaviour Change Wheel (BCW) framework, emphasizing educational programmes, hands-on training, and infrastructural improvements.

Findings

The study identified key barriers, including limited awareness of ChD among healthcare professionals, reliance on symptomatic diagnosis, environmental constraints, and inadequate public and professional engagement with ChD. We proposed tailored interventions to enhance primary healthcare personnel competencies through education, training, and infrastructure adjustments.

Interpretation

The study advocates for a paradigm shift in ChD management towards early intervention and comprehensive care. It highlights the importance of a team-based strategy aligned with the WHO's Neglected Tropical Diseases roadmap, particularly in remote areas. This approach addresses healthcare workers' challenges, fostering a more proactive and informed ChD management strategy.

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