Barriers to Treatment Access for Chagas Disease in Mexico

Background: According to World Health Organization (WHO) prevalence estimates, 1.1 million people in Mexico are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease (CD). However, limited information is available about access to antitrypanosomal treatment. This study assesses the extent of access in Mexico, analyzes the barriers to access, and suggests strategies to overcome them. Methods and Findings: Semi-structured in-depth interviews were conducted with 18 key informants and policymakers at the national level in Mexico. Data on CD cases, relevant policy documents and interview data were analyzed using the Flagship Framework for Pharmaceutical Policy Reform policy interventions: regulation, financing, payment, organization, and persuasion. Data showed that 3,013 cases were registered nationally from 2007–2011, representing 0.41% of total expected cases based on Mexico's national prevalence estimate. In four of five years, new registered cases were below national targets by 11–36%. Of 1,329 cases registered nationally in 2010–2011, 834 received treatment, 120 were pending treatment as of January 2012, and the treatment status of 375 was unknown. The analysis revealed that the national program mainly coordinated donation of nifurtimox and that important obstacles to access include the exclusion of antitrypanosomal medicines from the national formulary (regulation), historical exclusion of CD from the social insurance package (organization), absence of national clinical guidelines (organization), and limited provider awareness (persuasion). Conclusions: Efforts to treat CD in Mexico indicate an increased commitment to addressing this disease. Access to treatment could be advanced by improving the importation process for antitrypanosomal medicines and adding them to the national formulary, increasing education for healthcare providers, and strengthening clinical guidelines. These recommendations have important implications for other countries in the region with similar problems in access to treatment for CD. Author Summary: Chagas disease is a vector-borne disease caused by the parasite Trypanosoma cruzi. The disease is most frequently transmitted by triatomine insects but can also be passed through blood donation or from mother to child at birth. Experts estimate that 8 million people are infected with Chagas disease globally and that 1.1 million of these infections are found in Mexico. Most public health programs for Chagas disease focus on preventing new infections through vector control and screening the blood supply. However, in recent years there has been a greater focus on treating the disease with one of two available medications, benznidazole or nifurtimox. This study explores access to these two drugs in Mexico. The study shows that less than 0.5% of those who are infected with the disease received treatment in Mexico in years. The study also identified important factors that limit access in Mexico, including the exclusion of both drugs from the national health insurance program and problems importing these medications. Finally, the paper suggests ways that these problems can be overcome in Mexico, while providing helpful insight for other countries that struggle with similar problems in treating this disease.