New York, 20 December 2016 — After 14 years of Chagas diagnoses, treatment and prevention efforts in Bolivia, the international medical humanitarian organisation Doctors Without Borders/Médecins Sans Frontières (MSF) ended its Chagas operations today by presenting Bolivia’s Ministry of Health with an operating manual for managing Chagas disease in rural areas. MSF, which has been serving patients in this country for 30 years, is calling on the Bolivian Ministry of Health, municipal authorities and the Bolivian National Chagas Program (PNCH) to increase resources and access to comprehensive care of this disease. Bolivia has the highest incidence of Chagas worldwide.
MSF has provided timely diagnosis to more than 114,000 people, detected more than 11,000 cases, and treated approximately 8,000 patients throughout Latin America. Chagas is endemic in 60 percent of Bolivia, where 4,440,000 people are at risk of infection.
The Comprehensive Care Manual for Chagas disease in rural areas reflects MSF’s experience in implementing a comprehensive care model in Monteagudo, Chuquisaca, which the Ministry of Health and PNCH launched successfully with technical support from MSF and financial support from the Municipal Council.
During two years of intervention in this municipality, 32 percent of the population—8,445 people as of November 2016—were screened. In 2016 alone, 1,088 people were diagnosed with Chagas, of whom about 58 percent have started treatment. This achievement is thanks to the simplification of diagnosis through the use of rapid tests, which has made it easier to diagnose patients in health centers in remote areas where there is the highest prevalence of the disease.
Currently, 13 of the 16 health facilities in the rural area of Monteagudo are conducting patient screenings. Additionally, comprehensive treatment is provided in 10 health centers where doctors are based. In the future, we hope that follow-up treatment can be performed by trained nursing staff, as is done for other diseases such as HIV and tuberculosis.
Thanks to the joint work with the Ministry of Health and PNCH, it has been demonstrated that it may be possible to integrate this model into health structures, as well as within the SAFCI model (Intercultural Community Family Health). It could be replicated in other regions of the country that also need it and, above all, so that the diagnosis and treatment of Chagas disease can be guaranteed for all patients. However, for this to happen, adequate resources will be needed for an appropriate response.
MSF recognises that there has been significant progress in the fight against Chagas, with improvements in vector control and improved access to treatment of the disease. However, despite the existence of Law 3374 since 2006, which declares Chagas disease a national priority for all provinces in the country, no regulations have been created to date to allow further progress in access to treatment for the entire population, including those with congenital Chagas or in managing complications of this disease, including those cases involving pacemaker implants.
According to data from the PNCH, 30,454 people were diagnosed in 2015, of which only 10 percent started treatment. The data also found that only 57 percent of newborns received treatment. To make treatment for the disease accessible to a greater number of people, it is vital to ensure that rapid tests are made available, as well as medicines in hospitals and rural health centers in endemic areas, in addition to technical training for health personnel. In this regard, MSF extremely concerned about the potential shortages of rapid tests in the country from early 2017 onwards.
MSF reiterates its commitment to continue providing technical support, if required, by participating in international platforms about Chagas care, while offering our experience gained over 18 years of fighting this disease, and urges the Bolivian government to provide greater access to diagnosis and treatment, and to invest the resources necessary for comprehensive care of Chagas disease.