title: Neglect of a Neglected Disease in Italy: The Challenge of Access-to-Care for Chagas Disease in Bergamo Area.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Ernestina Carla
authors.initials: EC
authors.lastname: Repetto
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Centre of Tropical Diseases, Sacro Cuore Hospital, Negrar-Verona, Italy; COHEMI Project, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Angheben
authors.affiliation: Centre of Tropical Diseases, Sacro Cuore Hospital, Negrar-Verona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Gobbi
authors.affiliation: COHEMI Project, Milan, Italy; Centre of Tropical Diseases and Community Epidemiology (CECOMET) Esmeraldas, Ecuador.
authors.forename: Mariella
authors.initials: M
authors.lastname: Anselmi
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Al Rousan
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Carlota
authors.initials: C
authors.lastname: Torrico
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Rosa
authors.initials: R
authors.lastname: Ruiz
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Ledezma
authors.affiliation: OIKOS Onlus, Bergamo, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Buoninsegna
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khogali
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: De Maio
authors.affiliation: Médecins Sans Frontières, Medical Department, Operational Centre Brussels, MSF-Italy, Rome, Italy.
authors.forename: Ada Maristella
authors.initials: AM
authors.lastname: Egidi
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Maccagno
authors.affiliation: Médecins Sans Frontières, Operational Centre Brussels, MSF-Belgium, Brussels, Belgium.
authors.forename: Silvia
authors.initials: S
authors.lastname: Garelli
mesh_terms: D000293:Adolescent; D000328:Adult; D014355:Chagas Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003153:Community Health Services; D005260:Female; D006266:Health Education; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007843:Latin America / Q000208:ethnology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D058069:Neglected Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014344:Trypanocidal Agents