6. When Peace Gives Health a Chance. A patient-centered route: The "RIAS"
Evidence shows that when detection and treatment occur through primary healthcare, this improves people’s adherence and responses to treatment and reduces the costs incurred by those who seek care and those who provide it. Dr. Mauricio Vera, who heads the Chagas program, explains that in the departments with the highest incidence of the disease in Colombia (Casanare, Boyacá, Santander, and Arauca), the Comprehensive Health Care Route for Chagas (RIAS) has been implemented for several years now, helping people organize the sequence of interventions necessary for the effective care of the population through the implementation of PAHO’s Guide for the Diagnosis and Treatment of Chagas Disease, as well as Colombia’s guidelines for clinical care of the disease and Comprehensive Health Care Policy.
According to the data from some of the departments where the RIAS program for Chagas has been implemented, under the pilot project developed in collaboration with DNDi, the number of persons diagnosed may increase until 13-fold and the number of persons treated h increased 5-fold. This shows that it is possible to diagnose and provide early treatment at the first tier of healthcare, before the disease develops further complications, which increases the likelihood of recovery. RIAS has also made it possible to improve the availability of treatment for all people, and thus achieve a reduction in the suffering of the affected population, and an according reduction in the costs to families and to the healthcare system in general.
In the three-year period from 2019 to 2021, in the midst of the pandemic, it was only possible to screen 5.1% of pregnant women at risk of transmitting Chagas to their babies, and only 60% of newborn screenings were achieved.
However, the pandemic was only part of the problem in this respect. One of the big problems is that healthcare for people with Chagas, continues to be provided largely by specialists and not by primary healthcare workers, which contributes to increases in the cost of care. This increase affects, on the one hand, the patients who have to cover expenses of transportation, food and accommodation; on the other hand, it impacts the Health providers because it means additional tests and specialized referrals which, if they are needed in some cases, are not necessary for the majority of cases who can initiate the treatment much earlier. Additionally, some of the laboratory tests necessary for starting treatment, such as liver tests, require authorizations from insurers or health promotion entities (EPS), which leads to delays.
The use of decentralized diagnostic tests and the training of healthcare personnel are some other things that healthcare providers at the first level of care must commit to offer. If this does not happen, according to the health authorities, the current approach will not work, and the achievements demonstrated in high-incidence areas will not be expandable to the rest of the country. The effectiveness of the RIAS program depends on the private and public health promotion entities’ ability to implement it.
The fact that there is now peace in municipalities, that were previously inaccessible under armed conflict, provides an opportunity to give more attention to neglected diseases such as Chagas. The progression of the disease should be stopped at the front line of healthcare access: primary healthcare system. If the RIAS model can be coordinated with the collaboration of all the actors (private and public) that provide healthcare services, Colombia can lead the good news against Chagas in the region.
Report compiled during field visits by Javier Sancho and Ulrich-Dietmar Madeja. Images from Jorge Martinez.
Thanks to the health authorities of the vector and Chagas programs in Boyacá, Colombia, and to the support team made up of Laura, Rafael, Germán and more, without whose support it would have been impossible.
To arrive on time to interrupt Chagas disease: