A retrospective study on Chagas disease detection and management in Tremedal and Novo Horizonte: Insights prior to the Oxente Chagas Bahia Project

Chagas disease (CD) remains a persistent public health challenge in endemic areas of Brazil, where access to diagnosis, clinical staging, and etiological treatment is often limited. Tremedal and Novo Horizonte, municipalities in the state of Bahia, continue to report chronic cases despite advances in vector control. This study provides a retrospective assessment of CD detection and clinical management in these municipalities prior to the full implementation of the Oxente Chagas Bahia Project. We analyzed individuals tested for CD serology between 2019 and 2023 using data from the Laboratory Environment Manager (GAL) system and electronic primary care records (e-SUS). Sociodemographic characteristics, seropositivity, turnaround time for serological testing, and clinical manifestations were evaluated. A total of 472 individuals underwent serological testing. Testing volume increased markedly in Tremedal over time, whereas Novo Horizonte initiated screening only in 2023. Fourteen individuals (3.0%) tested positive for anti-Trypanosoma cruzi antibodies, all from Tremedal; 13 were included in the clinical analysis. The median age of confirmed cases was 52 years, and 61.5% were female. Among the 13 confirmed cases, the indeterminate form predominated (61.5%), followed by the cardiac and mixed forms (15.4% each) and the digestive form (7.7%) Electrocardiographic conduction abnormalities predominated among individuals with cardiac involvement, while severe digestive manifestations, including megacolon and megaesophagus, were documented in three individuals. Median turnaround time for serological results was longer in Tremedal than in Novo Horizonte. Documentation of etiological treatment with benznidazole was limited, with treatment records identified for only two of the thirteen confirmed cases in the available medical records. These findings highlight the ongoing burden of chronic CD, substantial gaps in screening and treatment, and the need to strengthen diagnostic access and guideline-based management. This study establishes a critical pre-intervention baseline for evaluating the impact of the Oxente Chagas Bahia Project in endemic municipalities.