Rethinking Chagas: Reshaping the Agenda for Chagas Disease in the United States.

Repensando el Chagas: Reorganizando la Agenda para la enfermedad de Chagas en los Estados Unidos.


Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

La Coalición Global de Chagas, Fundación Mundo Sano, y el Harvard T.H. Chan School of Public Health, reúnen a un gran número de expertos para discutir una nueva agenda para abordar la enfermedad de Chagas en los Estados Unidos.


8:30-9:00 Registration for Participants

9:00-9:20 Welcome and Opening Remarks

Joaquim Gascon, Chagas Coalition
Jenny Sanchez, Latin American Society of Chagas (LASOCHA)

9:20-9:30 Objectives of the Workshop

Michael R. Reich, Harvard T.H. Chan School of Public Health

9:30-10:50 Session 1: Screening for T. cruzi in the US: opportunities and challenges
The United States has seen a growth in screening efforts for Chagas disease in
high-risk geographies such as Los Angeles, Virginia, Texas and East Boston. This
session will focus on three themes: (1) the evidence base for a screening guideline
for Chagas disease in the U.S., (2) existing models for screening for Chagas
disease; and (3) screening for special populations. The speakers will present the
scientific rationale of screening and discuss the benefits and challenges of the
existing models. These speakers will also include a discussion of engaging special
populations including blood donors, transplant donors and recipients, and pregnant
women. The discussion addresses the evidence-base and evidence gaps for a
national screening guideline for Chagas disease in the US.

Moderator: Jennifer Manne-Goehler, Harvard Medical School
Presenters: Caryn Bern, University of California San Francisco and Sheba Meymandi, UCLA Olive View Center

10:50-11:10 Break

11:10-11:20 Special Talk: PAHO’s framework for elimination of mother-to-child disease transmission - EMTCT Plus

Luis Castellanos, Pan American Health Organization

11:20-12:40 Session 2: Diagnostic considerations for T. cruzi in high-risk US populations
Confirming the diagnosis of Chagas disease is a major challenge in health-care
settings that serve large populations at risk of T. cruzi infection. This section will
focus on three challenges in diagnosis: (1) the diagnostic infrastructure for Chagas
disease in the US following the approval of benznidazole; (2) diagnostic
discordance and how to optimize confirmatory testing with available diagnostic
tools; and (3) barriers to linkage to confirmatory testing after a positive screening
test. The speakers will review current options for screening and diagnostic
confirmation and present data on test performance in both population-based
screening efforts and clinical cohorts, with a focus on the factors associated with
discordance and how providers are managing discordant results. They will present
existing data on losses to care from screening to confirmatory diagnosis. The 3 session
will also discuss the current infrastructure needs for diagnostic confirmation and how
this may evolve with approval of benznidazole.

Moderator: Melissa Nolan, University of South Carolina
Presenters: Colin Forsyth, DNDi and Yagahira Castro, Johns Hopkins Bloomberg School of Public Health

12:40-12:50 Special Talk: CDC’s perspectives (remote participation)

Susan Montgomery, Centers for Disease Control and Prevention

12:50-13:50 Lunch

13:50-14:00 Special Talk: Supply of benznidazole after the FDA approval

Salustiano Pérez, Exeltis USA

14:00-15:20 Session 3: Treatment programs for Chagas disease in the United States
There is increasing evidence of a large burden of Chagas disease in the United
States, but relatively few patients who receive appropriate medical evaluation and
treatment after diagnosis. This session will discuss (1) current models of care for
Chagas disease; (2) barriers to successful treatment completion for both healthcare
providers and patients; and (3) strategies for ensuring a stable, affordable supply of
benznidazole, given recent FDA-approval of the drug and changes in its supply
chain. The presenters will describe several existing models of care and outline the
challenges that may arise given recent approval of benznidazole.

Moderator: Sergio Sosa-Estani, DNDi
Presenters: Rachel Marcus, MedStar Health and LASOCHA and Salvador Hernandez, UCLA Olive View

15:20-15:40 Break

15:40-17:00 Session 4: Social and communication strategies to reach Chagas disease
patients Chagas disease patients often belong to hard-to-reach subgroups in society.
It is necessary, therefore, to create better connections between health systems, health
care providers, and populations at risk. This session will discuss: (1) patient-side
barriers to treatment, including legal status and insurance; (2) physician education
to address social, cultural and psychological barriers to care; and (3) strategies to
motivate both physicians and patients to use treatment when appropriate. The
presenters will describe examples of projects that reach out to Chagas disease
patients and will discuss social and communication strategies that can be applied in
other contexts.

Moderator: Christina Coyle, Albert Einstein College of Medicine
Presenters: Paula Stigler Granados, Texas State University and Joaquim Gascon, ISGlobal Chagas Initiative

17:00-17:50 Open Discussion

Moderator: Michael R. Reich, Harvard T.H. Chan School of Public Health

17:50-18:00 Concluding Remarks