Using Cascade Charts to Highlight the Impact of Rapid Diagnostic Testing on Chagas Disease Care Open Access

Boxwell, Rachel (Spring 2023)

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Background: Chagas disease is a neglected tropical disease endemic to South and Central America. It is estimated that 6-7 million people are infected with the Chagas parasite and up to 70 million people are at risk of getting the disease. If left untreated, the parasite can persist for decades, if not the patient’s entire life. Of those with Chagas, 30-40% can experience symptoms that affect the cardiac, gastroenterological, and nervous systems. Complications can range from developing a megastomach to sudden death. These symptoms are frequently not attributed to Chagas disease, which allows knowledge about Chagas to go widely unknown and developments to fight the disease few and far between.


Methods: Methods included researching the price of purchasing a rapid diagnostic tests and calculating the number of people that will need to participate in testing to reach 25% coverage of the at risk population in Colombia. This information will be shown using a cascade chart to show the number of participants and the expected results of increased testing and treatment.


Results: To reach 25% testing coverage of the at-risk population in Colombia, 1,204,944 people would need to get tested. Using this number, we made a series of assumptions leading to 105,553 Colombians testing positive for Chagas, and 105,260 people staying to receive their test results. These numbers would lead to 82,103 people receiving Chagas treatment and 51,314 people completing the treatment regimen. We will need 2,403,656 Chagas STAT PAK RDTs (rapid diagnostic test) which would cost $14,421,936 USD. The increased number of people getting tested, and treatment would initially increase DALYs (disability adjusted life years), but eventually there would be a decrease in DALYs.


Conclusion: The implementation of RDTs to reach 25% testing coverage for the at-risk population in Colombia would have impact on how Chagas is treated in Colombia. Chagas is a widely neglected disease and by increasing the number of those diagnosed it will become much more difficult to ignore. The future of Chagas disease testing and treatment lies on the shoulders of those in the health community.

Table of Contents

Chapter 1: Introduction. 1

1.1 Rationale. 1

1.2 Problem statement 1

1.3 Purpose statement 1

1.4 Research question. 2

1.5 Mission statement 2

1.6 Context 2

Chapter 2: Literature review.. 5

2.1 Disease background. 5

2.2 Current status. 10

2.3 Malaria Comparison. 14

2.4 Research question. 17

Chapter 3: Methods. 18

3.1 Parameters. 18

3.2 Markov Model and DALYs. 19

3.3 Test Selection. 21

3.4 Data Collection. 23

3.5 Cascade Charts. 26

Chapter 4: Results. 27

4.1 Current Cascade Chart 27

4.2 Increased RDT Use. 32

4.3 Cascade Chart with RDT intervention. 33

4.4 Findings. 39

Chapter 5: Limitations, Conclusion, and Discussion. 40

5.1 Limitations. 40

5.2 Conclusion and Discussion. 41

Bibliography 43

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