The epidemiology of Chagas disease in the UK: a mixed methods study to inform equitable and evidence-based approaches to migrant health screening

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Chagas disease is a long-term infection caused by a parasite (Trypanosoma cruzi) which is spread mainly by insects which live in South America, Central America and Mexico. It can also be passed from mother to child in pregnancy, and through blood transfusions and organ transplantations. The UK is home to 250,000 people from parts of the world where they may have been infected before they migrated. Most people live with the infection for years without any symptoms. About a third of people infected will go on to develop heart and gut disease, often 20-40 years later. Six different genetic types of the parasite exist in different parts of the Americas and these may influence disease type and severity. It is estimated that 97% of people with Chagas disease in the UK are undiagnosed and this project looks at how we can best find people with Chagas disease to get them tested and linked into specialist care.Early diagnosis and treatment can prevent heart and gut complications and the risk of passing on the infection to babies during pregnancy. A screening test (a blood test), can tell us whether someone has the infection but - as we don't know exactly where in Latin America most people are infected, we don't know who it's most important to screen in the UK. This project aims to answer the following questions:1. How common is Chagas disease in migrants from Latin America living in the UK?2. How common is it when we test different people in different settings (at the GP surgery, pregnant women at their antenatal appointments and people attending community events with local charities)?3. What types of people are most at-risk of Chagas disease?4. What genetic types of parasite are people infected with?5. What is the best way to find people with Chagas disease and get them tested and treated?To answer these questions, I will invite people from at-risk countries to complete a questionnaire and have a blood test for Chagas disease. I will invite people through their GP surgeries, pregnant women at their antenatal appointments and I will also organise testing events with local charities. People who test positive will be referred to a specialist clinical for further tests and treatment. They will also be invited for a different blood test, to look at the parasite genetics. Finally, I will interview people invited to screening, and professionals responsible for designing and delivering screening programmes, to understand what they think are the key components of a good screening programme for Chagas disease. At the end of this study, we hope to have all of the information required in order to design a screening programme for Chagas disease which reaches the people at greatest risk.