# Clinical Protocols for the Initial Evaluation and Follow-Up of Patients with Chronic Chagas Disease: A Proposal for Referral Centers

## TL;DR

This paper proposes standardized clinical protocols for evaluating and managing patients with chronic Chagas disease, aiming to improve care in referral centers worldwide.

## Contribution

The paper introduces a replicable, multidisciplinary care model based on over three decades of institutional experience.

## Key findings

- The protocol includes dual serological confirmation and clinical staging for accurate diagnosis.
- Multidisciplinary follow-up involving cardiology, gastroenterology, and psychology is recommended for comprehensive care.
- Specific guidelines are provided for managing T. cruzi/HIV coinfection and adverse drug reactions.

## Abstract

Chagas disease (CD) remains a major global health challenge and requires standardized, multidisciplinary, and evidence-based clinical approaches. This article aims to present and systematize the model of clinical routines developed at the Clinical Research Laboratory on Chagas Disease (Lapclin-Chagas), INI/Fiocruz, for the initial evaluation and longitudinal follow-up of patients with chronic CD. The proposal is intended to serve as a replicable and adaptable framework for referral centers in both endemic and non-endemic settings. Using a descriptive qualitative design, institutional protocols, national and international guidelines, and expert consultations were analyzed to construct a comprehensive care model. The resulting protocol integrates diagnostic pathways (including dual serological confirmation and clinical staging), criteria for etiological treatment, and coordinated multidisciplinary follow-up involving cardiology, gastroenterology, pharmaceutical care, nutrition, psychology, and social support. Specific pathways are also presented for Trypanosoma cruzi (T. cruzi)/HIV coinfection, laboratory accidents, and monitoring of adverse reactions to benznidazole. By consolidating more than three decades of institutional experience into operational workflows, this proposal offers an innovative contribution to the organization of CD care and provides actionable guidance for health systems seeking to improve diagnostic accuracy, therapeutic adherence, patient safety, and long-term outcomes.