The use of rapid diagnostic tests for chronic Chagas disease: An expert meeting report

Freddy Perez, Debbie Vermeij, Roberto Salvatella, Luis Gerardo Castellanos and Andrea Silvestre de Sousa

PLOS Neglected Tropical Diseases, 2024, vol. 18, issue 8, 1-10

Abstract: Chagas disease, caused by Trypanosoma cruzi, affects millions of people globally and is associated with significant underdiagnosis and undertreatment. Current diagnostic algorithms face challenges in remote regions. We aimed to review the potential of rapid diagnostic tests (RDTs) for screening or diagnosing chronic Chagas disease in endemic areas. An expert panel representing scientific and academic institutions from the Americas convened with the aim of discussing the use of RDTs. The study employed the nominal group technique, gathering insights from diverse experts during a 3-day meeting. Panel discussions covered RDT application, research protocols, and regulatory mechanisms. The results indicate that RDTs play a crucial role in surveillance and screening, although limitations in sensitivity and specificity exist. The expert group recommends standardized protocols, emphasizes the importance of cost-effectiveness assessments, and highlights the need to consider geographic validation. Despite these challenges, RDTs present a promising avenue for improving Chagas disease diagnosis in resource-limited settings. Future research and a collaborative approach are deemed essential for effective implementation.Author summary: Chagas disease, caused by the Trypanosoma cruzi parasite, affects approximately 7 million people globally, with potential cardiac or digestive complications in 30% of cases. Underdiagnosis and undertreatment in Latin America result from its often-silent progression, emphasizing the need for early and accurate diagnosis. A meeting of representatives from scientific and academic institutions discussed the use of rapid diagnostic tests (RDTs) for chronic Chagas disease covering RDT application, research protocols, and regulatory mechanisms, emphasizing the important role of this tool in rapidly detecting T. cruzi-specific antibodies. RDTs offer breakthroughs for remote areas. Currently recommended for screening, experts suggest evaluating their expanded use for definitive individual diagnosis, emphasizing their portability, minimal blood requirement, and rapid results. Challenges, including variability in RDT sensitivity and specificity, call for further research and evidence-based recommendations. The expert group highlights the need for standardized diagnostic protocols, reviewing regulatory aspects, and advocating for updates to diagnostic lists and improved supply management. In conclusion, the expert meeting provided a roadmap for optimizing RDTs in chronic Chagas disease diagnosis, balancing potential benefits with existing challenges. The proposed generic protocol aims to guide multicenter studies, positioning RDTs as valuable tools in addressing this public health issue across the Americas.

Date: 2024
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DOI: 10.1371/journal.pntd.0012340

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