# An Exploratory Survey-Based Evaluation of Primary Care Providers’ Knowledge and Diagnosis of Neglected Tropical Diseases in Texas

## TL;DR

This study explores how well primary care providers in Texas recognize and report neglected tropical diseases, finding significant knowledge gaps and reporting barriers.

## Contribution

The study provides preliminary insights into Texas PCPs' knowledge and diagnostic capabilities regarding NTDs, highlighting educational and procedural gaps.

## Key findings

- Most providers had limited experience diagnosing NTDs, with 58.3% reporting never diagnosing one.
- Only 50% were aware of the reportable disease list and reporting timelines in Texas.
- Knowledge gaps and lack of awareness were identified as major barriers to proper NTD reporting.

## Abstract

Objective: The purpose of this survey is to determine the current level of neglected tropical disease (NTD) knowledge among primary care providers (PCPs), determine the ability of Texas PCPs to identify and diagnose a patient with an NTD, and assess the current knowledge of and identify barriers to NTD reporting mandates and procedures by Texas PCPs.

Background: As global temperatures increase, Texas' geographic outlook continues to change, causing vectors of NTDs to widen their endemic zones. Furthermore, PCPs can range from nurse practitioners to physicians, with varying representations depending on location and availability. As such, it is pertinent to understand the current knowledge gaps of NTDs, their clinical presentation, and the proper diagnostic tools.

Methods: From February 2024 to July 2024, a 23-question Qualtrics survey (Qualtrics, Provo, UT) was distributed via external and social media outreach, targeting primary health providers, including physicians (Doctor of Medicine/Doctor of Osteopathic Medicine, DO), physician assistants, and nurse practitioners, in any Texas healthcare setting. Questions inquired about knowledge regarding NTDs, appropriate diagnostic tests, and knowledge and attitudes toward reporting the disease in the state of Texas.

Results: A total of 21 survey responses were obtained, with nine being excluded due to incompletion. The majority of survey respondents were DOs (58.3%), practiced family medicine (41.7%), and practiced in Bexar County (58.3%), with an estimated average of 11 years of practice experience. As defined by the World Health Organization, 58.3% of respondents reported never having been diagnosed with an NTD. Seventy-five percent of respondents were aware of the proper reporting requirements outlined in Texas Administrative Code Chapter 97, Title 25. However, 50% needed to be made aware of the reportable disease list and the required timeline for reporting; 66.7% of respondents cited knowledge of the disease as the main barrier to incomplete reporting.

Discussion: This study demonstrates that only a few providers in Texas, namely Bexar County, could accurately identify NTD diagnostic tests, which may highlight the lack of knowledge of NTD evaluation. Due to the nature of vector-transmitted NTDs, it is imperative to explore widespread educational methods for providers. Expanding access to online reporting platforms for outpatient providers is essential to mitigate barriers and streamline the process. This study was severely limited by selection bias, small sample size, generalizability, and geographic representation, and thus serves as a preliminary study to inform future research.