ABSTRACT This scoping review mapped, synthesized, and critically analyzed the evidence on financial toxicity in Chagas disease, focusing on its determinants, impacts, and management strategies. Financial toxicity refers to the financial burden and distress experienced by individuals and their families as a result of healthcare expenses. The review followed the Joanna Briggs Institute methodology and the PRISMA-ScR guidelines. Comprehensive searches were conducted across seven electronic databases and the gray literature. Studies were selected and data extracted independently using the population-exposure-outcome framework, and 14 studies included. Most studies described indicators of the economic burden of Chagas disease rather than directly measuring patient-level financial toxicity. Substantial indirect costs were associated with absenteeism, productivity loss, and premature mortality, accounting for 44% to 75% of total costs. The findings also indicated that financial hardship may be intensified by structural vulnerabilities, including extreme poverty, lack of health insurance, and precarious migration status. Available evidence suggests that individuals affected by Chagas disease are at increased risk of healthcare-related financial hardship. However, studies directly assessing financial toxicity are scarce, with most relying on indirect economic indicators. This highlights an important gap in the literature and underscores the need for validated measures to evaluate financial toxicity in this population. Interventions that reduce financial barriers and strengthen access to healthcare services may help mitigate the economic consequences of Chagas disease. Future research should prioritize patient-centered assessments of financial toxicity to better inform policies and strategies aimed at reducing the financial burden associated with the disease.
ABSTRACT Background: This study aimed to synthesize evidence on the safety of tuberculosis-preventive treatment (TPT) in children aged <5 years, including those with immunocompromising conditions. Methods: A rapid review was conducted using PubMed, Embase, Virtual Health Library, and the Cochrane Library, including systematic reviews and primary studies. Results: Five studies were included, assessing isoniazid-based regimens. Adverse events were mild and reversible, such as transient liver enzyme elevations and peripheral neuropathy. Severe hepatotoxicity was rare and primarily reported in children with Human Immunodeficiency Virus (HIV). Conclusions: TPT appears generally safe in children aged <5 years; however, evidence remains limited for shorter regimens and immunocompromised populations.
ABSTRACT Leishmaniasis is one of the 10 leading neglected tropical diseases (NTDs), and cutaneous leishmaniasis is endemic in 19 countries in the Americas. This study aimed to systematically review the epidemiological and clinical characteristics, diagnostic methods, and outcomes associated with coinfection with American tegumentary leishmaniasis (ATL) and HIV in South American countries. This review was registered in the International Prospective of Systematic Reviews (PROSPERO; CRD42023138800). Searches were conducted in the following electronic scientific databases: the Biblioteca Virtual em Saúde, Literatura Latino-americana e do Caribe em Ciências da Saúde, SciVerse Scopus, the US National Library of Medicine (PubMed) and Web of Science, using subject headings from the Descritores em Ciências da Saúde and Medical Subject Headings in Portuguese, English and Spanish for studies published from 1987 to 2025. Two independent reviewers performed study selection. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Overall, 417 participants from 32 studies were included in this systematic review. Argentina, Bolivia, Brazil, Colombia, Ecuador, Paraguay and Peru reported concurrent ATL and HIV. In 29 studies (90.6%), the diagnosis was established based solely on clinical criteria. Diagnostic methods for ATL included culture and the Montenegro skin test, whereas those for HIV included Enzyme-Linked Immunosorbent Assay, Western blotting, and indirect immunofluorescence. Approximately 68% of the analyzed data were derived from case reports, limiting the overall level of evidence. Strengthening integrated surveillance is needed to improve the clinical management of patients with ATL-HIV coinfection and expand access to health services.
