Barriers to Chagas Disease Screening among Primary Care Providers in the United States

Chagas disease is a neglected tropical disease endemic to Latin America with approximately 10.5 million people infected worldwide. About 288,000 people live with Chagas disease in the United States, where it is officially not considered endemic and where screening is infrequent. This study aimed to identify barriers to routine Chagas disease screening among health care providers (HCPs) in U.S. primary care settings. This qualitative study consisted of semistructured individual and group interviews guided by the Theoretical Framework of Acceptability and the Health Belief Model frameworks. Between April 2021 and January 2022, 18 individual interviews and 10 group interviews were conducted virtually with physicians, nurse practitioners, and clinical support staff. Deductive thematic analysis was performed using NVivo software v. 11.0. Three major themes emerged. 1) Successful Chagas disease screening requires integration into clinical workflows and strong support from guidelines, 2) limited knowledge Chagas disease affects the likelihood of HCPs to screen, and 3) patients face many obstacles that need to be mitigated (e.g., lack of insurance, language barrier, and testing/treatment costs) before implementing a screening program. Barriers to implementing routine screening for Chagas disease in U.S. primary care settings exist but are modifiable. Screening for Chagas disease could be improved by raising awareness and interest among HCPs and affected communities. A key finding was that embedding screening into workflows through the use of electronic medical records is needed. These findings could lead to appropriate measures to address this gap in care, including enhanced screening and treatment of Chagas disease.