From delay to action: rethinking Chagas disease diagnosis with rapid testing in Colombia.

Chagas disease remains one of the most underdiagnosed neglected tropical diseases in Latin America despite the availability of accurate diagnostic tools. In Colombia, the number of diagnostic tests reported between 2017 and 2023 corresponded to fewer than 4% of the estimated population at risk, reflecting persistent diagnostic inequities associated with centralised laboratory-based algorithms that are poorly adapted to rural and underserved settings. National administrative data revealed substantial geographic disparities in testing intensity, particularly in departments with the largest populations at risk. Evidence from Colombian implementation experiences and recent economic evaluations indicates that sequential rapid diagnostic test (RDT)-based strategies can substantially reduce diagnostic costs while maintaining high diagnostic accuracy and operational feasibility. Expanding access to timely diagnosis may also contribute to preventing congenital transmission and reducing the long-term burden of chronic Chagas cardiomyopathy. Integrating RDTs into a phased national diagnostic strategy represents a feasible, evidence-based opportunity to reduce diagnostic inequities and strengthen Chagas disease control in Colombia.