Bridging the gap in Chagas disease management: a mixed-methods study using an implementation science approach within the Brazilian primary health care system—‘Implementa-Chagas/SaMi-Trop project’

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Background: Chagas Disease (ChD), a prevalent Neglected Tropical Disease in Latin America, affects millions and poses significant challenges in Brazil's primary healthcare system. Despite the availability of diagnostic tools and effective drugs, screening and treatment rates remain alarmingly low. This study aims to identify barriers and facilitators in ChD management, focusing on integrating services into routine healthcare operations. Methods: An exploratory sequential mixed-methods approach was used, combining focus groups with primary care physicians, in-depth interviews, and quantitative surveys with healthcare professionals. The Theoretical Domains Framework (TDF) and the Capability Opportunity Motivation-Behaviour (COM-B) model guided the analysis of decision-making processes in ChD management. Intervention strategies were developed using the Behaviour Change Wheel (BCW) framework, emphasizing educational programmes, hands-on training, and infrastructural improvements. Findings: The study identified key barriers, including limited awareness of ChD among healthcare professionals, reliance on symptomatic diagnosis, environmental constraints, and inadequate public and professional engagement with ChD. We proposed tailored interventions to enhance primary healthcare personnel competencies through education, training, and infrastructure adjustments. Interpretation: The study advocates for a paradigm shift in ChD management towards early intervention and comprehensive care. It highlights the importance of a team-based strategy aligned with the WHO's Neglected Tropical Diseases roadmap, particularly in remote areas. This approach addresses healthcare workers' challenges, fostering a more proactive and informed ChD management strategy. Funding: The NIH supported the study under the Sami-Trop cohort study (Grant n. U01AI168383).

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