Breaking the Silence - Impact Story
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Breaking the Silence

Increasing awareness, diagnosis and treatment of Chagas disease in Bolivia and Paraguay

Photo: Aleix Cabrera / ISGlobal

Chagas disease can be fatal, yet many people—mainly in Latin America—remain undiagnosed and untreated. To address this gap, ISGlobal’s Chagas Initiative, in collaboration with local Bolivian partners, launched the Chagas Platform, a care model designed for adults with Chagas disease. This model was scaled up to 52 primary care centres in Bolivia, significantly increasing access to diagnosis and treatment. Between 2009 and 2018, over 180,000 people were tested, more than 18,000 received treatment, 67% of health workers were trained, and over 10,000 community members were engaged to raise disease awareness. The model has since been expanded to Paraguay,  strengthening healthcare systems in the region, improving patient outcomes and increasing community participation.

What is the problem?

Over 6 million people worldwide are estimated to be infected with Trypanosoma cruzi, the parasite responsible for Chagas disease. Endemic to 21 countries in Latin America, the parasite is mainly transmitted by insect vectors and from mother to child. Up to one-third of those infected will go on to develop potentially fatal heart and digestive complications, many years after the initial infection.

Chagas is often described as a silent and silenced disease. It is silent because most people are unaware they are infected due to the absence of symptoms during the acute stage of the infection, and silenced because it predominantly affects impoverished populations whose voices are rarely heard. 

While the disease is curable, especially if treatment is initiated early after the infection, the challenge lies in the fact that only about 10% of the infected individuals are diagnosed and barely 1% get access to treatment. 

Key facts

52 primary healthcare centers adopted the Platform's care model
180K+ people tested in Bolivia (2009-2018)
18K+ people treated in Bolivia (2009-2018)
67% healthcare workers trained

What did our researchers do?

ISGlobal’s Chagas Initiative took a bold, multi-faceted approach to fight Chagas disease in Bolivia, one of the countries with the highest prevalence of T. cruzi infection in the world. In collaboration with the Spanish Agency for International Cooperation for Development (AECID), Fundación CEADES, Universidad Mayor de San Simón (Cochabamba, Bolivia), Universidad Autónoma Juan Misael Saracho (Tarija, Bolivia) and the National Chagas Programme in Bolivia, it created the Bolivian Platform for the Comprehensive Care of Patients with Chagas Disease. 

Launched in 2008 with seven centres, the Platform’s mission was to provide care to chronically affected people. It operated on a model based on four pillars: providing care, training health personnel, conducting research, and engaging with the community. Seven years later, this model was successfully expanded into a network of 52 primary care centres of the Bolivian national health system, ensuring that the disease management model became standardised and integrated into regular health services.

Community engagement was central to the Platform’s success. Educational campaigns to raise awareness of Chagas disease reached over 10,000 people through local languages like Quechua and Spanish. ISGlobal and its partners worked—and still work—closely with indigenous communities, mothers' clubs, and the education sector to inform and mobilise the population in the fight against Chagas. 

What changes has our research contributed to?

More people diagnosed and treated

The Bolivian Chagas Platform grew from seven centres in 2009 to 52 in 2015, increasing access to Chagas disease diagnosis and care, and transforming lives and communities. By the end of 2018, over 181,000 people had been tested for T. cruzi infection, more than 57,000 had a positive diagnosis, and more than 18,000 were treated. The platform’s 52 centres now cover 75% of the population in three of the regions most affected by the disease in  Bolivia (Cochabamba, Chuquisaca and Tarija). 

Strengthened local capacity 

Part of the Platform’s work involved training health workers and researchers in Bolivia. Since 2009, more than 1,370 health professionals have been trained in Chagas disease management through workshops, sessions and other training activities. Several clinical trials were conducted in the participating centres, with the consequent training of local professionals. Additionally, Bolivian and Spanish students participated in academic exchange experiences, and two Bolivian PhD students were also trained. 

All of the 52 primary healthcare centres to which the model was extended have implemented standardised care for Chagas disease (Chagas Healthcare Network) through a decentralised, horizontal scale-up process. 

Expanding to Paraguay

Building on this success, ISGlobal implemented the platform model in Paraguay’s Chaco region in collaboration with the Ministry of Public Health, and with the support from AECID and Fundación PROBITAS. In Paraguay, the focus is on women of childbearing age, as the country eliminated household transmission by the main vector,Triatomine infestans, in 2018. However, about 5% of pregnant women in the country are still infected, which means that an estimated 400 children are born with the infection each year. 

In addition to strengthening the health infrastructure and capacities, a Global Laboratory Initiative project was launched with the local partner Centro de Información y Recursos para el Desarrollo (CIRD) to refurbish laboratories at the Teniente Irala Fernández and Campo Aceval health centres in the Chaco region, significantly improving the region’s diagnostic capacity. Together, both facilities serve nearly 30,000 people in these remote areas.

Moreover, a triangular cooperation initiative (Bolivia, Paraguay, ISGlobal), co-funded by the EU (ADELANTE project), has fostered knowledge exchange between health professionals in Bolivia, Paraguay, and other endemic countries leading to capacity building among professionals and laying the groundwork for replicating the model of care.

New standardised guidelines for better care

ISGlobal helped Paraguay to develop and implement the first national guidelines for the clinical management of adult patients with Chagas disease and contributed to the country’s guidelines for the control of mother-to-child transmission and guidelines for entomological surveillance and vector control.  

The integration of standardised clinical care protocols into the national health system contributes to strengthened primary healthcare, improving patient outcomes and public health.

Community awareness and destigmatisation

Through extensive community engagement and co-creation efforts, ISGlobal and its partners are helping to drive behavioural changes in Bolivia and Paraguay.

These efforts have reached more than 10,000 people in both Quechua (37%) and Spanish (63%). The initiative engaged with indigenous communities, mothers' clubs, and the education sector, to encourage people to seek treatment at the improved health units. In Paraguay, community radios have broadcasted powerful testimonies from people receiving treatment, amplifying the voices of rural and marginalised communities and destigmatising the disease. 

Importantly, engagement with communities and healthcare workers in both countries has brought attention to Chagas and raised awareness that it is a preventable—and treatable—disease.

Links and references