03013nas a2200361   4500000000100000008004100001653001000042653002100052653001900073100001500092700001600107700001200123700001500135700001200150700001400162700001600176700001400192700001100206700001400217700001900231700001400250700002000264700001400284700001300298700001500311700001400326245011300340856007900453300001300532490000600545520208600551022001402637       2015                            d10aItaly10aHealth screening10aChagas disease1 aRepetto EC1 aZachariah R1 aKumar A1 aAngheben A1 aGobbi F1 aAnselmi M1 aAl Rousan A1 aTorrico C1 aRuiz R1 aLedezma G1 aBuoninsegna MC1 aKhogali M1 aVan den Bergh R1 aDe Maio G1 aEgidi AM1 aMaccagno B1 aGarelli S00aNeglect of a neglected disease in Italy: The challenge of access-to-care for Chagas disease in Bergamo Area.  uhttp://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004103   ae00041030 v93 a<p><strong>OBJECTIVES: </strong>Chagas disease (CD) represents a growing problem in Europe; Italy is one of the most affected countries but there is no national framework for CD and access-to-care is challenging. In 2012 Médecins Sans Frontières (MSF) started an intervention in Bergamo province, where many people of Latin American origin (PLAO) are resident. A new model-of-care for CD, initiated by Centre for Tropical Diseases of Sacro Cuore Hospital, Negrar (CTD), the NGO OIKOS and the Bolivian community since 2009 in the same area, was endorsed. Hereby, we aim to describe the prevalence of CD and the treatment management outcomes among PLAO screened from 1st June 2012 to 30th June 2013.</p>

<p><strong>METHODS: </strong>Retrospective cohort study using routine program data. Screening sessions were done in Bergamo at OIKOS outpatient service and serological confirmation, staging and treatment for CD was offered at the CTD. MSF provided health education on CD, awareness generation prior to screening days, pre-test and post-test counselling through cultural mediators of Latin American origin.</p>

<p><strong>RESULTS: </strong>Of 1305 PLAO screened, 223(17%) had CD. Among 210 patients eligible for treatment, 102(49%) were lost-to-follow-up before treatment. The median delay from diagnosis to treatment was 4 months (range 0.7-16.6 months). Among 108 started on treatment, 63(58%) completed treatment, 36(33%) interrupted treatment, (33 for drug side-effects, two for patients decision and one due to pregnancy), 6(6%) were lost-to-follow-up and 3(3%) were on treatment at study censuring.</p>

<p><strong>CONCLUSION: </strong>In this first study focusing on process of care for CD in Italy, less than 30% of patients completed treatment with drop-outs along the cascade of care. There is an urgent need to involve affected communities and local regional health authorities to take part to this model-of-care, adapting it to the local epidemiology. The Italian health authorities should take steps in advocating for a change in the current paradigm.</p>
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