Design and feasibility of an implementation strategy for the use of Chagas guidelines at the primary healthcare level: A pilot study using the Consolidated Framework for Implementation Research

KAREN KLEIN; JAVIER ROBERTI; MARIEL ROUVIER; MARÍA BELIZAN; MARÍA LUISA CAFERATTA; MABEL BERRUETA; JUAN PEDRO ALONSO

Jornada; XVII Jornada sobre la enfermedad de Chagas. La respuesta de los sistemas de salud a la enfermedad de Chagas; 2022

Introduction: Chagas is a public health problem, especially in Latin America, exacerbated by migratory movements and increasing urbanization. Argentina has the highest number of cases in the region, with 1,500,000 infected people1, with mother-to-child as the primary mode of transmis¬sion. Vertical transmission has been significantly reduced by treating women of childbearing age; several guidelines in the region recommend treatment as a primary prevention strategy for the child and a secondary prevention strategy for women and their families. Despite recommendations, women of childbearing age are not always treated, and children do not receive timely diagnosis and treatment.Aim: To design an implementation strategy to improve using Chagas guidelines at the primary health-care level and pilot it to assess its feasibility and the factors that influence its implementation. Methods: Feasibility study using the Consolidated Framework for Implementation Research (CFIR). The study included a formative evaluation with mixed method: semistructured interviews, ob-servations and secondary data collection. The adapted intervention was piloted in three primary health care centres in Chaco, Argentina. Results: We developed a multifaceted implementation strategy including training, flowcharts and reminders, a register of suspected and confirmed Chagas cases, and the selection of a management facilitator. The pilot study took place between September 2019 and May 2020. The implementation level was heterogeneous and varied depending on the components Facilitating factors: simplicity of the intervention, professionals’ willingness to expand the indi¬cation of serologic tests, and staff commitment to the adoption of intervention components. Main barriers:, change of authorities at the local level, some professionals´ reluctance to administer etiological treatment; staff shortages, lack of diagnostic supplies (linked to contextual factors) and the health emergency caused by the COVID-19 pandemic. Conclusions: To improve implementation, behavioural change strategies should be applied to address some of the main barriers, including support actions offered by opinion leaders, medical experts, and local health authorities; also, rapid diagnostic tests should be readily available to maintain behaviour changes. We suggest further refinement of the strategy and its implementation in a larger num¬ber of centres to assess outcomes prospectively with a hybrid implementation research design.