Barriers to surveillance and control of re-emergence of the Chagas disease vector Triatoma infestans in Arequipa, Peru

Vector control is usually designed as a top-down system with limited capacity to respond to the unique characteristics of each epidemiological setting, or to adjust to routine stressors that challenge ongoing programs, such as resource limitations and competing priorities. Here, we investigated barriers in Chagas disease vector surveillance and control systems in Arequipa, Peru. We conducted in-depth interviews and a focus group with key stakeholders (n=32) at different levels of the health system and community. For interviews, we used process maps to illustrate the workflow for passive and active surveillance. Additionally, we held a focus group with vector control specialists to present the findings from the interviews and discuss the results. We identified barriers at each step of the process, including systemic, operational, financial, and policy limitations. For passive surveillance, community participation was limited by practical challenges in capturing the insect and uncertainty about the pathways to report it. Systemic barriers were related to the use of a data system that did not meet the needs for recording and managing data on vector control activities. At the policy level, the establishment of quotas on the number of houses staff are required to inspect ignores important determinants for infestation and lacks an appropriate sampling design. We discuss the impact of the reported barriers to effective conduction of surveillance and control activities and the initiatives and strategies that have been designed and assessed to bridge these gaps in order to collaboratively design a more resilient health system.