title: Barriers to treatment access for Chagas disease in Mexico.
abstract: BACKGROUND
  According to World Health Organization (WHO) prevalence estimates, 1.1 million people in Mexico are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease (CD). However, limited information is available about access to antitrypanosomal treatment. This study assesses the extent of access in Mexico, analyzes the barriers to access, and suggests strategies to overcome them.
  
  
  RESULTS
  Semi-structured in-depth interviews were conducted with 18 key informants and policymakers at the national level in Mexico. Data on CD cases, relevant policy documents and interview data were analyzed using the Flagship Framework for Pharmaceutical Policy Reform policy interventions: regulation, financing, payment, organization, and persuasion. Data showed that 3,013 cases were registered nationally from 2007-2011, representing 0.41% of total expected cases based on Mexico's national prevalence estimate. In four of five years, new registered cases were below national targets by 11-36%. Of 1,329 cases registered nationally in 2010-2011, 834 received treatment, 120 were pending treatment as of January 2012, and the treatment status of 375 was unknown. The analysis revealed that the national program mainly coordinated donation of nifurtimox and that important obstacles to access include the exclusion of antitrypanosomal medicines from the national formulary (regulation), historical exclusion of CD from the social insurance package (organization), absence of national clinical guidelines (organization), and limited provider awareness (persuasion).
  
  
  CONCLUSIONS
  Efforts to treat CD in Mexico indicate an increased commitment to addressing this disease. Access to treatment could be advanced by improving the importation process for antitrypanosomal medicines and adding them to the national formulary, increasing education for healthcare providers, and strengthening clinical guidelines. These recommendations have important implications for other countries in the region with similar problems in access to treatment for CD.
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Manne
authors.forename: Callae S
authors.initials: CS
authors.lastname: Snively
authors.forename: Janine M
authors.initials: JM
authors.lastname: Ramsey
authors.forename: Marco Ocampo
authors.initials: MO
authors.lastname: Salgado
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: Michael R
authors.initials: MR
authors.lastname: Reich
mesh_terms: D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D014355:Chagas Disease / Q000188:drug therapy*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008800:Mexico
chemical_list: D000981:Antiprotozoal Agents