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Objectives. To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.

Methods. Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.

Results. Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.

Conclusions. Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.

Objetivos. Calcular las tasas de cobertura del tamizaje del cáncer cervicouterino y evaluar la distribución espacial y las agrupaciones de departamentos y municipios bolivianos.

Métodos. Se calcularon las tasas estandarizadas de cobertura con el método de estandarización directa. Se utilizó la prueba de la I de Moran global para determinar si había autocorrelación espacial en la cobertura, y se aplicó la prueba de la Gi* de Getis y Ord para encontrar posibles agrupaciones espaciales de municipios donde la cobertura fuese alta o baja.

Resultados. La cobertura general fue baja. En el 2022, en Bolivia se aplicó el tamizaje del cáncer cervicouterino a alrededor del 14% de las mujeres de entre 20 y 69 años. Se observan importantes inequidades geográficas en las tasas de cobertura tanto entre departamentos como entre municipios. A nivel municipal hay grandes diferencias, con valores que van del 59% a menos del 1%. Se observaron zonas de cobertura alta en el nordeste y el sudeste de Bolivia, concretamente en los departamentos de Pando, Chuquisaca y Tarija, mientras que las zonas de cobertura baja se ubicaban en los departamentos de Beni y Santa Cruz.

Conclusiones. Bolivia aún está muy lejos de alcanzar la meta de la Organización Mundial de la Salud de una cobertura del tamizaje del cáncer cervicouterino del 70%. Los presentes resultados indican dónde debe reforzarse el programa de tamizaje para mejorar la capacidad de respuesta del sistema de salud boliviano para atender las necesidades de salud reproductiva de las mujeres.

Objetivos. Estimar as taxas de cobertura do rastreamento do câncer do colo do útero e avaliar aglomerados e a distribuição espacial entre departamentos e municípios na Bolívia.

Métodos. Taxas padronizadas de cobertura do rastreamento do câncer do colo do útero foram calculadas por meio do método de padronização direta. Utilizou-se o índice I de Moran global para investigar a ocorrência de autocorrelação espacial na cobertura do rastreamento e estatística Getis-Ord Gi* para identificar aglomerados espaciais de municípios com cobertura alta (hot spot) ou baixa (cold spot).

Resultados. A cobertura geral foi considerada baixa. Aproximadamente 14% das mulheres de 20 a 69 anos realizaram o rastreamento na Bolívia em 2022. Foram constatadas grandes iniquidades geográficas nas taxas de cobertura do rastreamento do câncer do colo do útero, tanto entre os departamentos como entre os municípios. No nível municipal, o rastreamento apresentou enormes diferenças, variando de 59% a menos de 1%. Foram identificados hot spots no noroeste e no sudeste da Bolívia, especificamente nos departamentos de Chuquisaca, Pando e Tarija. Por outro lado, foram identificados cool spots nos departamentos de Beni e Santa Cruz.Conclusões. A Bolívia ainda está longe de alcançar a meta de 70% de cobertura do rastreamento estabelecida pela Organização Mundial da Saúde. Os resultados indicam áreas onde o programa de rastreamento precisa ser fortalecido para aprimorar a capacidade de resposta do sistema de saúde da Bolívia às necessidades de saúde reprodutiva das mulheres.

INTRODUCTION: Cutaneous leishmaniasis (CL), endemic in Bolivia, mostly affects poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages and a lack of safe conditions to deliver treatment are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in a Bolivian endemic area.

METHODS: The cost-per-patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N = 12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization. Costs were reported in 2017 international dollars (1 INT$ = 3.10 BOB).

RESULTS: Treating CL using ILPA was associated with a cost-saving of $248 per-patient-treated from the MoH perspective, and $688 per-patient-treated from the societal perspective. Switching first-line treatment to ILPA while maintaining the current budget would allow two-and-a-half times the current number of patients to be treated. ILPA remained cost-saving compared to SPA in the sensitivity analysis.

CONCLUSIONS: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.

Background: Leishmaniasis is a neglected tropical disease endemic in Bolivia that disproportionately affects people with little social and political capital. Although the treatment is provided free of charge by the Bolivian government, there is an under-utilization of treatments in relation to the estimated affected population. This study explores the experiences of patients with leishmaniasis and the challenges faced when searching for diagnosis and treatment in Bolivia using a human rights approach.

Methods: We conducted open-ended interviews with 14 participants diagnosed with leishmaniasis. The qualitative data were analysed using thematic analysis and were interpreted under a human rights approach to health care.

Results: Four themes emerged during data analysis: (1) the decision for seeking a cure takes time; (2) the severity of symptoms and disruption of functioning drives the search for Western medicine; (3) the therapeutic journey between Western and traditional medicine; and (4) accessibility barriers to receive adequate medical treatment. This study showed that access to health care limitations were the most important factors that prevented patients from receiving timely diagnosis and treatment. Cultural factors played a secondary role in their decision to seek medical care.

Conclusions: Accessibility barriers resulted in a large pilgrimage between public health care and traditional medicinal treatments for patients with leishmaniasis. This pilgrimage and the related costs are important factors that determine the decision to seek health care. This study contributes to the understanding of the under-utilisation problems of medical services in leishmaniasis and other similar diseases in remote and poor populations.

This study evaluates the level of underreporting of the National Program of Leishmaniasis Control (NPLC) in two communities of Cochabamba, Bolivia during the period 2013-2014. Montenegro skin test-confirmed cases of cutaneous leishmaniasis (CL) were identified through active surveillance during medical campaigns. These cases were compared with those registered in the NPLC by passive surveillance. After matching and cleaning data from the two sources, the total number of cases and the level of underreporting of the National Program were calculated using the capture-recapture analysis. This estimated that 86 cases of CL (95% confidence interval [CI]: 62.1-110.8) occurred in the study period in both communities. The level of underreporting of the NPLC in these communities was very high: 73.4% (95% CI: 62.1-110.8). These results can be explained by the inaccessibility of health services and centralization of the NPLC activities. This information is important to establish priorities among policy-makers and funding organizations as well as implementing adequate intervention plans.

Background: Cutaneous leishmaniasis (CL) is an endemic disease in Bolivia, particularly in the rainforest of Cochabamba, in the municipality of Villa Tunari. The precarious, dispersed, and poorly accessible settlements in these farming communities make it difficult to study them, and there are no epidemiological studies in the area. The aim of the present study was to identify the risk factors associated with cutaneous leishmaniasis.

Methods: A cross-sectional study was conducted in August 2015 and August 2016 in two communities of Villa Tunari, Cochabamba. The cases were diagnosed through clinical examinations, identification of the parasite by microscopic examination, and the Montenegro skin test. Risk factors were identified through logistic regression.

Results: A total of 274 participants (40.9% female and 59.1% male) were surveyed, of which 43% were CL positive. Sex was the only factor associated with CL with three times more risk for men than for women; this finding suggests a sylvatic mechanism of transmission in the area.

Conclusions: It is advisable to focus on education and prevention policies at an early age for activities related to either leisure or work. Further research is needed to assess the influence of gender-associated behavior for the risk of cutaneous leishmaniasis.

Introduction: Cutaneous leishmaniasis (CL) is endemic in Bolivia, mostly affecting poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages, a lack of conditions to deliver treatment safely, treatment interruption are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in an endemic area of Bolivia.

Methods: The cost per patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N=12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization using previous estimates of the extent of underreporting. Costs were reported in 2016 international dollars (1 INT$ = 3.10 BOB).

Results: Treating CL using ILPA was associated with a cost saving of $248 per patient treated from the MoH perspective, and $688 per patient treated from the societal perspective. ILPA was cost-saving even under a hypothetical increase of 80% in the number of cases treated. Switching first-line treatment would allow two-and-a-half times the current number of patients to be treated, while maintaining the current budget.

Conclusions: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.