Universidad Peruana Cayetano Heredia

A field trial of alternative targeted screening strategies for chagas disease in Arequipa, Peru

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dc.contributor.author Hunter, G.C.
dc.contributor.author Borrini-Mayorí, K.
dc.contributor.author Ancca Juárez, J.
dc.contributor.author Castillo Neyra, Ricardo
dc.contributor.author Verastegui Pimentel, Manuela Renee
dc.contributor.author Malaga Chavez, F.S.
dc.contributor.author del Cornejo Carpio, J.G.
dc.contributor.author Córdova Benzaquen, E.
dc.contributor.author Naquira Velarde, Cesar Gabriel
dc.contributor.author Gilman, Robert Hugh
dc.contributor.author Bern, C.
dc.contributor.author Levy, M.Z.
dc.date.accessioned 2022-01-18T19:34:37Z
dc.date.available 2022-01-18T19:34:37Z
dc.date.issued 2012
dc.identifier.uri https://hdl.handle.net/20.500.12866/11071
dc.description.abstract Background: Chagas disease is endemic in the rural areas of southern Peru and a growing urban problem in the regional capital of Arequipa, population ~860,000. It is unclear how to implement cost-effective screening programs across a large urban and periurban environment. Methods: We compared four alternative screening strategies in 18 periurban communities, testing individuals in houses with 1) infected vectors; 2) high vector densities; 3) low vector densities; and 4) no vectors. Vector data were obtained from routine Ministry of Health insecticide application campaigns. We performed ring case detection (radius of 15 m) around seropositive individuals, and collected data on costs of implementation for each strategy. Results: Infection was detected in 21 of 923 (2.28%) participants. Cases had lived more time on average in rural places than non-cases (7.20 years versus 3.31 years, respectively). Significant risk factors on univariate logistic regression for infection were age (OR 1.02; p = 0.041), time lived in a rural location (OR 1.04; p = 0.022), and time lived in an infested area (OR 1.04; p = 0.008). No multivariate model with these variables fit the data better than a simple model including only the time lived in an area with triatomine bugs. There was no significant difference in prevalence across the screening strategies; however a self-assessment of disease risk may have biased participation, inflating prevalence among residents of houses where no infestation was detected. Testing houses with infected-vectors was least expensive. Ring case detection yielded four secondary cases in only one community, possibly due to vector-borne transmission in this community, apparently absent in the others. Conclusions: Targeted screening for urban Chagas disease is promising in areas with ongoing vector-borne transmission; however, these pockets of epidemic transmission remain difficult to detect a priori. The flexibility to adapt to the epidemiology that emerges during screening is key to an efficient case detection intervention. In heterogeneous urban environments, self-assessments of risk and simple residence history questionnaires may be useful to identify those at highest risk for Chagas disease to guide diagnostic efforts. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Neglected Tropical Diseases
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Humans en_US
dc.subject Peru en_US
dc.subject Risk Factors en_US
dc.subject Cross-Sectional Studies en_US
dc.subject major clinical study en_US
dc.subject disease carrier en_US
dc.subject mass screening en_US
dc.subject parasite transmission en_US
dc.subject rural area en_US
dc.subject vector control en_US
dc.subject Prevalence en_US
dc.subject health survey en_US
dc.subject methodology en_US
dc.subject evaluation en_US
dc.subject Urban Population en_US
dc.subject age en_US
dc.subject Chagas Disease en_US
dc.subject Trypanosoma cruzi en_US
dc.subject household en_US
dc.subject economics en_US
dc.subject health care cost en_US
dc.subject infection risk en_US
dc.subject serology en_US
dc.subject blood sampling en_US
dc.subject Cost-Benefit Analysis en_US
dc.subject Mass Screening en_US
dc.subject cost benefit analysis en_US
dc.subject screening test en_US
dc.subject Triatominae en_US
dc.subject Health Assessment Questionnaire en_US
dc.subject Self-Examination en_US
dc.title A field trial of alternative targeted screening strategies for chagas disease in Arequipa, Peru en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pntd.0001468
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.06
dc.relation.issn 1935-2735


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