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Background  Peri-urban and urban settings have recently gained more prominence in studies on vector-borne transmission of  Trypanosoma cruzi  due to sustained rural-to-urban migrations and reports of urban infestations with triatomines. Prompted by the finding of  Triatoma infestans  across the rural-to-urban gradient in Avia Terai, an endemic municipality of the Argentine Chaco, we assessed selected components of domestic transmission risk in order to determine its variation across the gradient.    Methods  A baseline vector survey was conducted between October 2015 and March 2016, following which we used multistage random sampling to select a representative sample of  T. infestans  at the municipal level. We assessed  T. cruzi  infection and blood-feeding sources of 561 insects collected from 109 houses using kinetoplast DNA-PCR assays and direct enzyme-linked immunosorbent assays, respectively. We stratified triatomines according to their collection site (domestic or peridomestic), and we further categorized peridomestic sites in ecotopes of low- or high-risk for  T. cruzi  infection.    Results  The overall adjusted prevalence of  T. cruzi -infected  T. infestans  was 1.8% (95% confidence interval [CI] 1.3–2.3) and did not differ between peri-urban (1.7%) and rural (2.2%) environments. No infection was detected in bugs captured in the urban setting; rather, infected triatomines were mainly collected in rural and peri-urban domiciles, occurring in 8% of  T. infestans -infested houses. The main blood-feeding sources of domestic and peridomestic triatomines across the gradient were humans and chickens, respectively. The proportion of triatomines that had fed on humans did not differ between peri-urban (62.5%) and rural (65.7%) domiciles, peaking in the few domestic triatomines collected in urban houses and decreasing significantly with an increasing proportion of chicken- and dog- or cat-fed bugs. The relative odds ratio (OR) of having a  T. cruzi  infection was nearly threefold higher in bugs having a blood meal on humans (OR 3.15), dogs (OR 2.80) or cats (OR: 4.02) in a Firth-penalized multiple logistic model.    Conclusions   Trypanosoma cruzi  transmission was likely occurring both in peri-urban and rural houses of Avia Terai. Widespread infestation in a third of urban blocks combined with high levels of human–triatomine contact in the few infested domiciles implies a threat to urban inhabitants. Vector control strategies and surveillance originally conceived for rural areas should be tailored to peri-urban and urban settings in order to achieve sustainable interruption of domestic transmission in the Chaco region.

Trypanosoma cruzi infection in Triatoma infestans and high levels of human–vector contact across a rural-to-urban gradient in the Argentine Chaco