Diseño y factibilidad de una estrategia de implementación para uso de las Guías de atención de Chagas en el primer nivel de atención. Un estudio piloto aplicando el marco consolidado de investigación en implementación CFIR

KLEIN, KAREN; ROBERTI, JAVIER; ROUVIER, MARIEL; BELIZAN, MARÍA; ALONSO, JUAN PEDRO

Barcelona

Jornada; XVII Jornada sobre la enfermedad de Chagas; 2022

IntroductionChagas is a public health problem, especially in Latin America1, exacerbated by migratory movements and increasing urbanization2,3. 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 transmission4,5. Vertical transmission has been significantly reduced by treating women of childbearing age6-8; several guidelines in the region recommend treatment as a primary prevention strategy for the child and a secondary prevention strategy for women and their families9,10. Despite recommendations, women of childbearing age are not always treated, and children do not receive timely diagnosis and treatment11-14.ObjectivesTo design an implementation strategy to improve using Chagas guidelines at the primary healthcare level and pilot it to assess its feasibility and the factors that influence its implementation.MethodsFeasibility study using the Consolidated Framework for Implementation Research (CFIR). The study included a formative evaluation with mixed method15,16: semistructured interviews, observations and secondary data collection. The adapted intervention was piloted in three primary health care centres in Chaco, Argentina.ResultsWe 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 (Table 1).The pilot study took place between September 2019 and May 2020. The implementation level was heterogeneous and varied depending on the components (Table 2).Facilitating factors: simplicity of the intervention, professionals? willingness to expand the indication 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.ConclusionsTo 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 changes17. We suggest further refinement of the strategy and its implementation in a larger number of centres to assess outcomes prospectively with a hybrid implementation research design.