1
|
Pavinati G, de Lima LV, Radovanovic CAT, Magnabosco GT. Geoprogrammatic disparities in the performance of tuberculosis indicators in the homeless population in Brazil: an ecological approach. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230048. [PMID: 37909629 PMCID: PMC10626908 DOI: 10.1590/1980-549720230048.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To analyze the performance and spatial distribution of tuberculosis control indicators in the homeless population in Brazil. METHODS Ecological study, which had the regions and federal units of Brazil as the unit of analysis. The indicators considered, referring to the period from 2015 to 2021, were: proportion of HIV testing, proportion of tuberculosis-HIV co-infection, proportion of directly observed treatment, and proportion of outcomes (cure, treatment abandonment and death). The calculation was performed on each ecological unit, as recommended by the Ministry of Health. For the production of geographic figures, the technique of natural breaks was used. RESULTS It was identified that people living on the streets had: low HIV testing, especially in Pará (71.7%); high proportion of tuberculosis-HIV coinfection, especially in Rio Grande do Sul (39.9%); and unsatisfactory implementation of directly observed treatment, mainly in Paraíba (7.7%). With regard to outcomes, there was a high rate of treatment abandonment, with a higher proportion in Roraima (52.9%), and a high number of deaths, with an emphasis on Mato Grosso do Sul (23.1%), which also recorded the worst cure rate (28.7%). CONCLUSION There was evidence of poor performance of tuberculosis control indicators in homeless people, with heterogeneous distribution between states and regions of the country, and it is clear that most of them had insufficient results. These data raise the persistence of difficulties and challenges inherent to the implementation of tuberculosis control strategies for this population in the national territory.
Collapse
Affiliation(s)
- Gabriel Pavinati
- Universidade Estadual de Maringá, Programa de Pós-Graduação em Enfermagem - Maringá (PR), Brasil
| | - Lucas Vinícius de Lima
- Universidade Estadual de Maringá, Programa de Pós-Graduação em Enfermagem - Maringá (PR), Brasil
| | | | | |
Collapse
|
2
|
Pinto PFPS, Santos BPSD, Teixeira CSS, Nery JS, Amorim LDAF, Sanchez MN, Barreto ML, Pescarini JM. Performance evaluation of tuberculosis control in Brazilian municipalities. Rev Saude Publica 2022; 56:53. [PMID: 35703607 PMCID: PMC9239336 DOI: 10.11606/s1518-8787.2022056004020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the performance of tuberculosis control in Brazilian municipalities. METHODS This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50-100 thousand, 100-300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease. RESULTS A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets - HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) -, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%). CONCLUSIONS Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.
Collapse
Affiliation(s)
| | - Beatriz Pinheiro Schindler Dos Santos
- Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Departamento de Saúde Coletiva I. Salvador, BA, Brasil
| | | | - Joilda Silva Nery
- Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Departamento de Saúde Coletiva I. Salvador, BA, Brasil
| | - Leila Denise Alves Ferreira Amorim
- Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Matemática. Departamento de Estatística. Salvador, BA, Brasil
| | - Mauro Niskier Sanchez
- Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade de Brasília. Faculdade de Ciências da Saúde. Departamento de Saúde Coletiva. Brasília, DF, Brasil
| | - Mauricio Lima Barreto
- Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Departamento de Saúde Coletiva I. Salvador, BA, Brasil
| | - Julia Moreira Pescarini
- Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,London School of Hygiene & Tropical Medicine. Faculty of Epidemiology and Population Health. London, UK
| |
Collapse
|
3
|
Sousa GJB, Maranhão TA, Leitão TDMJS, Souza JTD, Moreira TMM, Pereira MLD. Prevalence and associated factors of tuberculosis treatment abandonment. Rev Esc Enferm USP 2021; 55:e03767. [PMID: 34320115 DOI: 10.1590/s1980-220x2020039203767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of tuberculosis treatment abandonment and its associated factors. METHOD Cross-sectional study which used cases of tuberculosis in the System of Information on Notification Aggravations (Sistema de Informação de Agravos de Notificação) from 2001 to 2017 in Ceará state. This study included 74,006 cases and the outcome was the closing situation "treatment abandonment". A multivariate analysis was performed to estimate the association between the variables with abandonment. RESULTS Throughout the period, the abandonment rate was 12.54%. A higher abandonment prevalence was verified among people who live in the urban zone (PR = 2.45; 95%CI: 2.20-2.74), who are readmitted after abandonment (PR = 2.84; 95%CI: 2.68-3.01), among those notified as recurrent (PR = 1.22; 95%CI: 1.10-1.35) and among drinkers (PR = 1.50; 95%CI: 1.42-1.58). Those who were sputum smear-positive (PR = 1.11; 95%CI: 1.03-1.19) or for whom sputum smear was unperformed (PR = 1.30; 95%CI: 1.20-1.40), coinfection (PR = 2.04; CI95%: 1.89-2.21) and who were not submitted to serology (PR = 1.62; 95%CI: 1.53-1.71) have also a higher prevalence of tuberculosis treatment abandonment. CONCLUSION Tuberculosis treatment abandonment is associated to biological and social factors, habits, and health service structure.
Collapse
Affiliation(s)
- George Jó Bezerra Sousa
- Universidade Estadual do Ceará, Programa de Pós-graduação Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brasil
| | | | | | | | | | - Maria Lúcia Duarte Pereira
- Universidade Estadual do Ceará, Programa de Pós-graduação Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brasil
| |
Collapse
|
4
|
Cortez AO, Melo ACD, Neves LDO, Resende KA, Camargos P. Tuberculosis in Brazil: one country, multiple realities. J Bras Pneumol 2021; 47:e20200119. [PMID: 33656156 PMCID: PMC8332839 DOI: 10.36416/1806-3756/e20200119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify the determinants of tuberculosis-related variables in the various regions of Brazil and evaluate trends in those variables over the ten-year period preceding the end of the timeframe defined for the United Nations Millennium Development Goals (MDGs). METHODS This was an ecological analytical study in which we utilized eight national public databases to investigate the 716,971 new tuberculosis cases reported between 2006 and 2015. RESULTS Over the study period, there were slight reductions in the prevalence, incidence, and mortality associated with tuberculosis. Brazil did not reach the MDG for tuberculosis-related mortality. Among the performance indicators of tuberculosis control, there were improvements only in those related to treatment and treatment abandonment. In terms of the magnitude of tuberculosis, substantial regional differences were observed. The tuberculosis incidence rate was highest in the northern region, as were the annual mean temperature and relative air humidity. That region also had the second lowest human development index, primary health care (PHC) coverage, and number of hospitalizations for tuberculosis. The northeastern region had the highest PHC coverage, number of hospitalizations for primary care-sensitive conditions, and tuberculosis-related mortality rate. The southern region showed the smallest reductions in epidemiological indicators, together with the greatest increases in the frequency of treatment abandonment and retreatment. The central-west region showed the lowest overall magnitude of tuberculosis and better monitoring indicators. CONCLUSIONS The situation related to tuberculosis differs among the five regions of Brazil. Those differences can make it difficult to control the disease in the country and could explain the fact that Brazil failed to reach the MDG for tuberculosis-related mortality. Tuberculosis control measures should be adapted to account for regional differences.
Collapse
Affiliation(s)
- Andreza Oliveira Cortez
- . Programa de Pós-Graduação em Ciências da Saúde, Grupo de Pesquisa em Tuberculose e Doenças Infecciosas, Universidade Federal de São João del-Rei, Divinópolis (MG) Brasil
| | - Angelita Cristine de Melo
- . Programa de Pós-Graduação em Ciências da Saúde, Grupo de Pesquisa em Tuberculose e Doenças Infecciosas, Universidade Federal de São João del-Rei, Divinópolis (MG) Brasil.,. Programa de Pós-Graduação em Ciências Farmacêuticas, Grupo de Pesquisa em Farmácia Clínica, Assistência Farmacêutica e Saúde Coletiva, Universidade Federal de São João del-Rei, Divinópolis (MG) Brasil
| | - Leonardo de Oliveira Neves
- . Grupo de Pesquisa em Micrometeorologia de Ecossistemas, Instituto Federal Catarinense, Rio do Sul (SC) Brasil
| | - Karina Aparecida Resende
- . Programa de Pós-Graduação em Ciências Farmacêuticas, Grupo de Pesquisa em Farmácia Clínica, Assistência Farmacêutica e Saúde Coletiva, Universidade Federal de São João del-Rei, Divinópolis (MG) Brasil
| | - Paulo Camargos
- . Programa de Pós-Graduação em Ciências da Saúde, Grupo de Pesquisa em Tuberculose e Doenças Infecciosas, Universidade Federal de São João del-Rei, Divinópolis (MG) Brasil
| |
Collapse
|
5
|
Campoy LT, Arakawa T, Andrade RLDP, Ruffino-Netto A, Monroe AA, Arcêncio RA. QUALITY AND MANAGEMENT OF CARE TO TUBERCULOSIS/HIV COINFECTION IN THE STATE OF SÃO PAULO, BRAZIL. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the quality and management of care to tuberculosis/HIV coinfection in the state of São Paulo, Brazil. Methods: a descriptive study involving municipalities having at least five cases of tuberculosis/HIV coinfection in the Brazilian state of São Paulo notified in the tuberculosis notification system. To analyze the quality and management of care to tuberculosis/HIV coinfection, indicators were designed, based on tuberculosis evaluability assessment studies, and validated in Brazil. The municipalities were grouped according to their care quality and then submitted to multiple correspondence analysis. Results: the study formed a group with 18 municipalities (42.86%) with satisfactory care and management quality, and another group with 24 municipalities (57.14%) with a quality characterized as unsatisfactory. In the municipalities that showed a satisfactory result, the investigation identified a low proportion of tuberculosis/HIV coinfection, a low AIDS incidence rate, intermediate population size, and high coverage of the Community Health Workers’ Program and Family Health Strategy. The municipalities with unsatisfactory quality had a high proportion of tuberculosis/HIV coinfection and a high AIDS incidence rate. Conclusion: the study reveals the defining characteristics of quality and management of care to tuberculosis/HIV coinfection as chronic conditions, bringing relevant elements regarding the mobilization of resources and investments in the municipalities where these are necessary. Additionally, the investigation shows that health results are critical where care quality is unsatisfactory, pointing out the need for reorganizing care and the management of actions involving control of tuberculosis/HIV coinfection in these contexts.
Collapse
|
6
|
Scheffer MC, Prim RI, Wildner LM, Medeiros TF, Maurici R, Kupek E, Bazzo ML. Performance of centralized versus decentralized tuberculosis treatment services in Southern Brazil, 2006-2015. BMC Public Health 2018; 18:554. [PMID: 29699537 PMCID: PMC5922025 DOI: 10.1186/s12889-018-5468-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 04/17/2018] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis (TB) control programs face the challenges of decreasing incidence, mortality rates, and drug resistance while increasing treatment adherence. The Brazilian TB control program recommended the decentralization of patient care as a strategy for combating the disease. This study evaluated the performance of this policy in an area with high default rates, comparing epidemiological and operational indicators between two similar municipalities. Methods This study analyzed epidemiological and operational indicators on new cases of pulmonary tuberculosis reported in the Brazilian Notifiable Diseases Information System between 2006 and 2015. In addition, to characterize differences between the populations of the two studied municipalities, a prospective cohort study was conducted between 2014 and 2015, in which patients with new cases of culture-confirmed pulmonary tuberculosis were interviewed and monitored until the disease outcome. A descriptive analysis, the chi-square test, and a Poisson regression model were employed to compare TB treatment outcomes and health care indicators between the municipalities. Results Two thousand three hundred nine cases were evaluated, of which 207 patients were interviewed. Over the 2006–2015 period, TB incidence per 100,000 population in the municipality with decentralized care was significantly higher (39%, 95% CI 27–49%) in comparison to that of the municipality with centralized care. TB treatment default rate (45%, 95% CI 12–90%) was also higher in the municipality with decentralized care. During the two-year follow-up, significant differences were found between patients in centralized care and those in decentralized care regarding treatment success (84.5 vs. 66.1%), treatment default (10.7 vs. 25.8%), illicit drug use (27.7 vs. 45.9%), and homelessness (3.6 vs. 12.9%). The operational indicators revealed that the proportion of control smear tests, medical imaging, and HIV tests were all significantly higher in the centralized care. However, a significantly higher proportion of patients started treatment in the early stages of the disease in the municipality with decentralized care. Conclusions These data showed a low success rate in TB treatment in both municipalities. Decentralization of TB care, alone, did not improve the main epidemiological and operational indicators related to disease control when compared to centralized care. Full implementation of strategies already recommended is needed to improve TB treatment success rates.
Collapse
Affiliation(s)
- Mara Cristina Scheffer
- Departamento de Análises Clínicas for Programa de Pós-Graduação em Farmácia da, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rodrigo Ivan Prim
- Departamento de Análises Clínicas for Programa de Pós-Graduação em Farmácia da, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Leticia Muraro Wildner
- Departamento de Análises Clínicas for Programa de Pós-Graduação em Farmácia da, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Taiane Freitas Medeiros
- Departamento de Análises Clínicas for Programa de Pós-Graduação em Farmácia da, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rosemeri Maurici
- Departamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Emil Kupek
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Maria Luiza Bazzo
- Departamento de Análises Clínicas for Programa de Pós-Graduação em Farmácia da, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil. .,Laboratório de Biologia Molecular, Sorologia e Micobactérias, Departamento de Análises Clínicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Campos Universitário- Trindade, Florianopolis, SC, 88040-900, Brazil.
| |
Collapse
|