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

恰加斯病是由一种寄生虫(克氏锥虫)引起的长期感染，这种寄生虫主要通过生活在南美洲、中美洲和墨西哥的昆虫传播。它还可以在怀孕期间从母亲传给孩子，并通过输血和器官移植传播。英国有来自世界各地的25万人，他们可能在移民前就被感染了。大多数人在感染中生活多年，没有任何症状。大约三分之一的感染者会继续患上心脏和肠道疾病，通常是在20-40年后。美洲不同地区存在六种不同的寄生虫遗传类型，这些类型可能会影响疾病的类型和严重程度。据估计，英国97%的恰加斯病患者没有得到诊断，这个项目着眼于如何最好地找到恰加斯病患者进行测试，并将他们联系到专家护理中。早期诊断和治疗可以防止心脏和肠道并发症以及在怀孕期间将感染传染给婴儿的风险。筛查测试(血液测试)可以告诉我们某人是否感染了病毒，但由于我们不知道拉丁美洲大多数人到底是在哪里感染的，我们不知道在英国筛查谁最重要。这个项目旨在回答以下问题：1.在居住在英国的拉丁美洲移民中，恰加斯病有多常见？2.当我们在不同的环境中(在全科医生诊所、孕妇产前预约时以及与当地慈善机构一起参加社区活动的人)对不同的人进行测试时，这种情况有多普遍？3.哪些类型的人最有可能患查加斯病？4.人们感染了什么类型的寄生虫？5.发现查加斯病患者并让他们进行检测和治疗的最佳方式是什么？要回答这些问题，我将邀请高危国家的人们完成一份问卷，并对恰加斯病进行血液测试。我将通过全科医生手术邀请人们，邀请孕妇参加产前预约，我还将与当地慈善机构一起组织测试活动。检测呈阳性的患者将被转介到专科诊所进行进一步测试和治疗。他们还将被邀请进行一次不同的血液测试，以查看寄生虫的遗传学。最后，我将采访被邀请参加筛查的人，以及负责设计和提供筛查计划的专业人员，以了解他们认为良好的恰加斯病筛查计划的关键组成部分是什么。在这项研究结束时，我们希望获得所需的所有信息，以便设计一项针对恰加斯病的筛查计划，从而接触到风险最高的人群。

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.