{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:44:29Z","timestamp":1791873869725,"version":"4.3.4"},"reference-count":48,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,6]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>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.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0559","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:52:48Z","timestamp":1773154368000},"page":"857-864","source":"Crossref","is-referenced-by-count":1,"title":["Barriers to Chagas Disease Screening among Primary Care Providers in the United States"],"prefix":"10.4269","volume":"114","author":[{"given":"Malwina N.","family":"Carrion","sequence":"first","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Kienle","sequence":"additional","affiliation":[{"name":"Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bourque","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari-Lynn","family":"Drainoni","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"},{"name":"Department of Health Law Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA;"},{"name":"Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha S.","family":"Hochberg","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madolyn","family":"Dauphinais","sequence":"additional","affiliation":[{"name":"UMass Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Mello","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula E.","family":"Stigler Granados","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, School of Public Health, San Diego State University, San Diego, California, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davidson H.","family":"Hamer","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA;"},{"name":"Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA;"},{"name":"Boston University Center on Emerging Infectious Diseases, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J R Soc Med","first-page":"451","article-title":"Carlos Chagas and the discovery of Chagas\u2019 disease (American trypanosomiasis)","volume":"74","author":"Lewinsohn","year":"1981"},{"key":"b2","series-title":"Trans R Soc Trop Med Hyg","first-page":"513","article-title":"Carlos Chagas (1879\u20131934): The discovery of Trypanosoma cruzi and of American trypanosomiasis (footnotes to the history of Chagas\u2019 disease)","volume":"73","author":"Lewinsohn","year":"1979"},{"key":"b3","series-title":"Lancet","first-page":"1388","article-title":"Chagas disease","volume":"375","author":"Rassi","year":"2010"},{"key":"b4","series-title":"Lancet","first-page":"82","article-title":"Chagas disease","volume":"391","author":"P\u00e9rez-Molina","year":"2018"},{"key":"b5","series-title":"Clin Cardiol","first-page":"883","article-title":"Chagas\u2019 heart disease","volume":"23","author":"Rassi","year":"2000"},{"key":"b6","series-title":"Lancet Infect Dis","first-page":"284","article-title":"Global, regional, and national burden of Chagas disease, 1990\u20132023: A systematic analysis for the Global Burden of Disease Study 2023","volume":"26","year":"2026"},{"key":"b7","series-title":"JAMA","first-page":"2171","article-title":"Evaluation and treatment of Chagas disease in the United States: A systematic review","volume":"298","author":"Bern","year":"2007"},{"key":"b8","series-title":"Emerg Infect Dis","first-page":"1691","article-title":"Chagas disease, an endemic disease in the United States","volume":"31","author":"Beatty","year":"2025"},{"key":"b9","series-title":"Clin Infect Dis","first-page":"e52","article-title":"An estimate of the burden of Chagas disease in the United States","volume":"49","author":"Bern","year":"2009"},{"key":"b10","series-title":"Emerg Infect Dis","first-page":"1313","article-title":"Updated estimates and mapping for prevalence of Chagas disease among adults, United States","volume":"28","author":"Irish","year":"2022"},{"key":"b11","series-title":"Emerg Infect Dis","first-page":"871","article-title":"Physician awareness of Chagas disease, USA","volume":"16","author":"Stimpert","year":"2010"},{"key":"b12","series-title":"Pediatr Infect Dis J","first-page":"e24","article-title":"Survey of Pediatric Infectious Diseases Society members about congenital Chagas disease","volume":"37","author":"Edwards","year":"2018"},{"key":"b13","series-title":"Am J Trop Med Hyg","first-page":"891","article-title":"Survey of obstetrician-gynecologists in the United States about Chagas disease","volume":"83","author":"Verani","year":"2010"},{"key":"b14","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"803","article-title":"Characteristics of patients for whom benznidazole was released through the CDC-sponsored investigational new drug program for treatment of Chagas disease\u2014United States, 2011\u20132018","volume":"67","author":"Herwaldt","year":"2018"},{"key":"b15","series-title":"PLoS Negl Trop Dis","first-page":"e0007447","article-title":"Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States","volume":"13","author":"Forsyth","year":"2019"},{"key":"b16","series-title":"J Infect Dis","first-page":"1601","article-title":"Recommendations for screening and diagnosis of Chagas disease in the United States","volume":"225","author":"Forsyth","year":"2022"},{"key":"b17","series-title":"Curr Trop Med Rep","first-page":"185","article-title":"The importance of screening for Chagas disease against the backdrop of changing epidemiology in the USA","volume":"9","author":"Ayres","year":"2022"},{"key":"b18","series-title":"Open Forum Infect Dis","first-page":"S609","article-title":"The cascade of care for the strong hearts Chagas disease screening and treatment program in East Boston, Massachusetts","volume":"6","author":"Manne-Goehler","year":"2019"},{"key":"b19","series-title":"BMC Health Serv Res","first-page":"88","article-title":"Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework","volume":"17","author":"Sekhon","year":"2017"},{"key":"b20","series-title":"Cambridge Handbook of Psychology, Health and Medicine","first-page":"97","author":"Abraham","year":"2007"},{"key":"b21","series-title":"Field Methods","first-page":"59","article-title":"How many interviews are enough? An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006"},{"key":"b22","series-title":"Am J Trop Med Hyg","first-page":"380","article-title":"Improving clinician awareness of and screening for Chagas disease with an educational intervention","volume":"111","author":"Wheelock","year":"2024"},{"key":"b23","series-title":"Prev Med Rep","first-page":"101036","article-title":"Electronic medical record alert activation increases hepatitis C and HIV screening rates in primary care practices within a large healthcare system","volume":"17","author":"Tapp","year":"2020"},{"key":"b24","article-title":"A Guide to Setting up Screening for Chagas Disease in Outpatient Settings.","year":"2023"},{"key":"b1","series-title":"J R Soc Med","first-page":"451","article-title":"Carlos Chagas and the discovery of Chagas\u2019 disease (American trypanosomiasis)","volume":"74","author":"Lewinsohn","year":"1981"},{"key":"b2","series-title":"Trans R Soc Trop Med 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