Challenges in the care of patients with Chagas disease in the Brazilian public health system: A qualitative study with primary health care doctors

Background: Care to patients with Chagas disease (CD) is still a challenge for health systems in endemic and non-endemic countries. In the Brazilian public health system, the expansion of Primary Health Care (PHC) services to remote and disadvantaged areas has facilitated the access of patients with CD to medical care, however this is in a context where care gaps remain, with insufficient public funding and inadequate distribution of services. Considering the need for studies on care to patients with CD in different settings, this study explored the challenges of family doctors to provide care to patients with CD in an endemic region in Brazil with high coverage of public PHC services. Methods and findings: This is a qualitative study. A focus group with 15 family doctors was conducted in a municipality participating in a multicenter cohort that monitors almost two thousand patients with CD in an endemic region in Brazil. The data were analyzed using a thematic content analysis technique. The family doctors pointed out the following challenges for care to patients with CD: unsatisfactory medical training (academic education not suitable for the clinical management of the disease, and lack of training on CD in PHC); uncertainties regarding antiparasitic treatment in the chronic phase of the disease; difficulty in patients’ access to specialized care when necessary, especially to the cardiologist; and trivialization of the disease by patients as a barrier to seeking care. Conclusion: The access of CD patients to adequate medical care, even in regions with high coverage of public PHC services, still represents an important challenge for health systems. The results of this study may contribute to the development of strategies to improve the clinical management of CD in PHC. Author summary: Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi which predominantly affects poor and vulnerable populations. In the Brazilian public health system, the expansion of Primary Health Care (PHC) services to remote and disadvantaged areas has facilitated the access of patients with CD to medical care. However, preliminary results from a cohort study that followed almost two thousand CD patients in an endemic region in Brazil showed that 74% of these patients were not followed by a doctor or were followed irregularly. Our study explored the challenges of family doctors to provide care to patients with CD in a municipality in that region through a qualitative approach. We conducted a focus group with 15 family doctors. The family doctors pointed out the following challenges for care to CD patients in PHC: unsatisfactory medical training; uncertainties regarding antiparasitic treatment in the chronic phase of the disease; difficulty in patient access to specialized care when necessary; and trivialization of the disease by patients as a barrier to seeking care. The results of this study may contribute to the development of strategies to improve the clinical management of CD in PHC.