Primary Care-Based Screening for Trypanosoma cruzi in High-Risk Populations: Results of the Strong Hearts Pilot in East Boston, Massachusetts

BACKGROUND: More than 300,000 people in the United States may be infected with Trypanosoma cruzi. This study describes the results of the Strong Hearts pilot project to integrate screening and facilitate referral for treatment for T. cruzi infection into primary care settings serving patients at high risk in Massachusetts. METHODS: We partnered with the Medicine, Pediatrics, Obstetrics, and Family Medicine divisions at the East Boston Neighborhood Health Center. Continuing education about Chagas disease was offered to healthcare providers, and community outreach to educate at-risk individuals and families was initiated. One-time screening for all patients under 50 years of age who lived in Mexico, South or Central America for at least 6 months was recommended. The initial screening test was an ELISA performed by a commercial laboratory. Confirmatory testing was performed at the Centers for Disease Control and Prevention (CDC) using serum saved at the health center laboratory. Patients with two positive tests were referred to the Infectious Disease Department of a partner institution for further evaluation and treatment. RESULTS: Three screening tests were ordered at the health center in the 3 months before the pilot. During the first 6 weeks of the pilot, participating providers ordered 203 screening tests. The patients screened included 90 (44%) women and 113 (56%) men; 90 (44%) were from El Salvador and 46 (23%) from Colombia. Thus far, results are available for 123 tests, among which 118 are negative and five are positive (one confirmed positive, one confirmed negative, and three pending). Two patients have been referred and seen by the partnering ID clinic, both within 6 weeks of the initial screening test. CONCLUSION: The burden of Chagas disease may be underappreciated even in facilities that serve high-risk patients. Our preliminary findings suggest that primary care-based screening for Chagas disease is feasible and embraced by providers and patients, in the context of appropriate education and a seamless system for referral and treatment. DISCLOSURES: All authors: No reported disclosures.