Fatores associados ao abandono do tratamento da tuberculose pulmonar no Maranhão, Brasil, no período de 2001 a 2010

[Abandonment of tuberculosis treatment in Brazil, 2012-2018: trend and spatiotemporal distribution]

Ecological study that analyzes the trend and the spatiotemporal distribution of new cases of tuberculosis (TB) that abandoned treatment in Brazil, notified in the Notifiable Diseases Information System, in the period from 2012 to 2018. For the study of the trend used the Prais-Winsten generalized linear regression model was used and the Moran Global and Local indices for spatial analysis. The mean and median proportion of TB treatment dropout in Brazil was 10.4%. The highest averages of the indicator were concentrated in the Southeast (10.78 ± 1.38), South (10.70 ± 2.94) and North (10.35 ± 1.13), and; in the states of Rondônia (14.35 ± 2.34), Rio Grande do Sul (13.60 ± 4.23) and Rio de Janeiro (12.64 ± 1.73), only Acre and Piauí showed this indicator below 5%. In Brazil, there was a tendency towards stability in the proportion of abandonment of TB treatment, a decrease in the North, Northeast and South regions and only in the Federal District there was growth. There was a heterogeneous and non-random distribution, with five capitals comprising the High-Risk cluster. We conclude that the proportion of TB treatment abandonment in Brazil is above what is acceptable and that the identification of high-risk areas can contribute to the elaboration and strengthening of more specific control actions.

Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil

Background

Tuberculosis (TB) presents a high burden of disease and is considered a global emergency by the World Health Organization (WHO), as the leading cause of death from infectious disease in adults. TB incidence is related directly to access to health services and socioeconomic determinants and inequality. Providing primary care settings can lead to improved access, shorter waiting times for patients, and enhanced TB case detection. The article aims to identify the spatial and temporal risk areas for TB and the relationship between TB cure and primary healthcare coverage from 2012 to 2014 in Rio de Janeiro, Brazil.

Methods

A cross-sectional study was conducted in Rio de Janeiro, Brazil. All cases of TB reported to the Information System on Diseases of Notification (SINAN) from 2012 to 2014 were included. Socioeconomic variables from the 2010 Brazilian national census were also added. Socioeconomic variables were selected from multivariate analysis using principal factors analysis. Spatial association was verified with generalized additive model (GAM). It was possible to identify areas at higher risk of failure to cure TB.

Results

TB rates showed strong positive spatial autocorrelation. TB cure rate varied according to schooling (individuals with complete secondary schooling had higher cure rates than illiterate individuals; OR 1.72, 95% CI 1.30–2.29), alcohol consumption (OR 0.47, 95% CI 0.35–0.64), contact investigation (OR 2.00, 95% CI 1.56–2.57), positive HIV serology (OR 0.31, 95% CI 0.23–0.42), and census tracts with higher elderly rates (OR 9.39, 95% CI 1.03–85.26). Individuals who had been covered by primary healthcare (PHC) for 35 to 41 months had 1.64 higher odds of cure, compared to those with no PHC coverage (95% CI 1.07–2.51).

Conclusion

A comprehensive risk map was developed, allowing public health interventions. Spatial analysis allowed identifying areas with lower odds of TB cure in the city of Rio de Janeiro. TB cure was associated statistically with time of coverage by primary healthcare. TB cure rate also varied according to sociodemographic factors like schooling, alcohol abuse, and population density.

This methodology can be generalized to other areas and/or other public health problems.

Highlights

We studied standardized municipal TB cure rates in an area of social inequality in Brazil.

TB rates showed strong positive spatial autocorrelation.

Higher rates were associated with population density and socioeconomic conditions. Illiterate individuals were less likely to achieve TB cure.

TB cure was less likely in individuals with HIV and alcohol abuse.

TB cure was greater in areas with high primary healthcare coverage.

Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis

BACKGROUND

We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors.

METHODS

A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram.

RESULTS

The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20-39 years (21.8%), had 4-7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy.

CONCLUSION

The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.

Tuberculosis in Northeastern Brasil (2001-2016): trend, clinical profile, and prevalence of risk factors and associated comorbidities

SUMMARY OBJECTIVE: To describe the temporal trend, clinical profile, and the prevalence of risk factors and associated comorbidities in new cases of tuberculosis in the Northeast (2001-2016). METHODS: A prevalence study involving all tuberculosis cases registered in Northeast Brasil, 2001-2016. Data were obtained from the National System of Notification of Disorders. For statistical analysis, the inflection point regression model and descriptive statistics were used. RESULTS: 331,245 cases of tuberculosis were reported. The overall incidence rate decreased from 44.84/100,000 inhabitants (2001) to 30.92/100,000 inhabitants (2016), with a decreasing trend (AAPC: −2.3; p<0.001). The profile was characterized by men (73.53%), age 20-59 years (73.56%), pulmonary tuberculosis (86.37%), positive smear microscopy (54.78%). The main risk factors and comorbidities were: AIDS (4.64%), HIV (12.10%), Diabetes mellitus (5.46%), alcohol (11.63%), institutionalized, (4.31%) and deprived of liberty (2.30%). The cure rate was 70.66% and the abandonment rate was 9.11%. CONCLUSIONS: Even with a reduced incidence, tuberculosis represents a real public health problem in the Northeast region. The profile was characterized by a male population, in economically-active age, lung smear-positive pulmonary presentation, and the risk factors and comorbidities of Aids, TB/HIV co-infection, diabetes mellitus, alcohol consumption, institutionalized and deprived of freedom reflect the complexity of the challenges in facing the disease.

Factors associated with recovery and the abandonment of tuberculosis treatment in the incarcerated population

OBJECTIVE

This study aimed to investigate the factors associated with the outcomes of recovery and abandonment in the incarcerated population with tuberculosis.

METHODS

A quantitative and observational analytical study was performed with data from the Notification Disease Information System (Sinan), tuberculosis data from the incarcerated population in the state of Paraiba from 2007 to 2016; Notifications of individuals over the age of 18, reported as "new cases" and the outcome, "recovery" or "abandonment" status were included. Those people who until December 2016 had no outcome information were excluded. Analyses were performed using bivariate and multivariate statistics from the Poisson regression.

RESULTS

Of the 614 notifications, most were male (93.8%). In the bivariate analysis, there was a statistically relevant association of outcomes with Acquired Immunodeficiency Syndrome (p = 0.044), Human Immunodeficiency Virus (HIV) serology (p = 0.048) and lack of completion of follow-up bacilloscopy (p = 0.001). In the adjusted multivariate analysis, Acquired Immunodeficiency Syndrome (RR = 1.998; 95%CI 1.078 - 3.704; p = 0.028) and lack of completion of follow-up bacilloscopy (RR = 5.251; 95%CI 2.158 - 12.583; p <0.001*) remained significantly associated with the dropout outcome.

CONCLUSION

Recovery and abandonment outcomes were mainly associated with whether the follow-up bacilloscopy was performed or not and Acquired Immunodeficiency Syndrome.

Abandonment of therapy in multidrug-resistant tuberculosis: Associated factors in a region with a high burden of the disease in Perú

Introduction: In the context of multidrug-resistant tuberculosis, abandonment of therapy represents a serious public health problem that affects the quality of life of patients, families, and communities. Managing this phenomenon places a burden on health systems since it causes free sources of transmission in the community, thereby increasing prevalence and mortality. Thus, there is a need to study factors associated with this problem. Objective: This study sought to identify risk factors associated with the abandonment of therapy by patients with multidrug-resistant tuberculosis in the Peruvian region of Callao. Materials and methods: We conducted an analytical case-control study (cases=80; controls=180) in patients under treatment from January 1st, 2010, to December 31, 2012. Risk factors were identified using logistic regression; odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results: The multivariate analysis identified the following risk factors: Being unaware of the disease (OR=23.10; 95% CI 3.6-36.79; p=0.002); not believing in healing (OR=117.34; 95% CI 13.57-124.6; p=0.000); not having social support (OR=19.16; 95% CI 1.32-27.77; p=0.030); considering the hours of attention to be inadequate (OR=78.13; 95% CI 4.84-125.97; p=0.002), and not receiving laboratory reports (OR=46.13; 95% CI 2.85-74.77; p=0.007). Conclusion: Health services must focus on the early detection of conditions that may represent risk factors to proactively implement effective, rapid and high-impact interventions.

Consensual improvement actions for the Tuberculosis Control Programme in Pernambuco state, Brazil: an e-Delphi study

OBJECTIVES

Tuberculosis (TB) remains a major public health problem, particularly in low and middle-income countries. The aim of this study is to consensualise improvement actions for the Tuberculosis Control Programme of the Pernambuco state (SPTC), Brazil.

METHODS

Firstly, a preliminary workshop was conducted with experts (n = 8), including key stakeholders and health professionals, to select structure and process indicators pertaining to the tuberculosis control programme. Then, an e-Delphi was carried out with a purposive sample of 11 local TB experts. The first-round questionnaire was comprised of 19 open-ended questions on possible improvement actions, based on programme indicators obtained in the previous stage. In the second-round experts rated each action for relevance and feasibility, using a four-point scale. In the last round the participants rated the actions again, in the light of group's answers. We used published criteria to define consensus at the outset of the study.

KEY FINDINGS

Eighty-nine improvement actions achieved a high degree of consensus in both feasibility and relevance in round three. Eighty-six actions were grouped under 19 structure and process indicators, while three were consideredcross-sectional in scope (i.e. related to more than one indicator). Ten out of the 86 actions obtained at least 70% of ratings on the highest score of the scale both for relevance and feasibility. These included: "Request and availability of sputum pots can be made by any health professional in the health unit".

CONCLUSIONS

The wide array of actions obtained in this Delphi represent a resource from which local SPTC services can select the actions most suitable for each context. The ten most relevant and feasible actions represent a particularly useful starting point to streamline change and potentially improve programme indicators.

Predictors of noncompliance to pulmonary tuberculosis treatment: An insight from South America

PURPOSE

To investigate the factors associated with a higher risk of noncompliance to tuberculosis (TB) treatment in Porto Alegre, Brazil.

METHODS

We identified 478 adult patients for this case-control study undergoing treatment for confirmed pulmonary TB. Cases (noncompliance) were defined as patients who stopped treatment for more than 30 consecutive days (n = 118). Controls were defined as all patients who completed treatment and were cured (n = 360). Factors associated with noncompliance were calculated with unadjusted and adjusted odds ratio (OR).

RESULTS

The rate of noncompliance in our study was 25%. The factors of noncompliance after adjustments in the overall population were, in order of magnitude, living in an area of lower income (OR = 4.35, 95%CI: 2.50-7.58), abuse of drugs (OR = 2.73, 95%CI: 1.47-5.09), nonadherence to a previous treatment regimen (OR = 2.1, 95%CI: 1.28-3.45), and history of smoking (OR = 1.72, 95%CI: 1.00-3.00). Age, race, gender, level of education, HIV infection or diabetes status were not associated with a higher risk of noncompliance. In the subgroup of re-treatment cases, poverty (OR = 2.65; 95%CI = 1.06-6.66), smoking history (OR = 2.94; 95%CI = 1.09-7.92), male gender (OR = 3.25; 95%CI = 1.32-8.0), and younger age (OR = 4.3; 95%CI = 1.15-16.07) were also associated with a higher risk of dropout.

CONCLUSION

Predictors of poor compliance to TB treatment were low income, abuse of drugs, re-treatment cases and history of smoking.

Factors associated with loss to follow-up and death in cases of drug-resistant tuberculosis (DR-TB) treated at a reference center in Rio de Janeiro, Brazil

Drug-resistant tuberculosis (DR-TB) poses a serious threat to tuberculosis (TB) control in Brazil and worldwide. The current study investigated factors associated with loss to follow-up and death in the course of treatment for DR-TB in a tertiary reference center in the city of Rio de Janeiro, Brazil. This was a retrospective cohort study of cases reported to the Information System on Special Treatments for Tuberculosis (SITETB) from January 1, 2012, to December 31, 2013. A total of 257 patients were reported to the SITETB and initiated treatment for DR-TB. Of this total, 139 (54.1%) achieved treatment success as the outcome, 54 (21%) were lost to follow-up, and 21 (8.2%) died. Following a multiple multinomial logistic regression analysis, the age bracket older than 50 years was the only protective factor against loss to follow-up, whereas less than eight years of schooling and reentry after loss to follow-up were considered risk factors. Reentry after loss to follow-up, relapse, and treatment failure appeared as risk factors. Our data reinforce the concept that loss to follow-up in drug-resistant tuberculosis is a serious public health problem, and that adequate follow-up of treatment is necessary in patients with this history and low schooling. A social support network for patients is also indispensable for avoiding unfavorable outcomes.

Cure rates for tuberculosis in the municipality of Rio de Janeiro, Brazil, in 2012 compared with coverage by, and time of establishment of, Family Health units, and socio-economic and demographic factors

Tuberculosis (TB) has high prevalence and is considered a world emergency by the World Health Organization (WHO), being the greatest cause of death from infectious diseases in adults. It is directly associated with access to health services and socio-economic factors. A reform of Primary Care in the municipality of Rio de Janeiro began in 2010, with coverage increasing from 7% in that year to 48.2% in 2014. This article compares the proportion of cures of TB, coverage by the Family Health Strategy (FHS), how long it has been in place, and socio-economic and demographic factors in the municipality of Rio, based on new cases notified in the year 2012. An association was found between cure of TB and the variable gender, being 40% greater in females - odds ratio 1.4 (CI95% 1.21-1.62); and with residence in favelas - OR 0.86 (CI95% 0.73-1.02), but there was no association with coverage of the FHS (OR 1.06; CI95% 0.92-1.22), nor with the time for which the teams had been in place. FHS coverage in the municipality of Rio was put in place as priority in areas of greater vulnerability; at the time of this study, more than 91% of the teams had been in place for less than five years before the date of diagnosis. These factors probably contributed to it not being possible to detect better results in the cure of tuberculosis in areas covered by the FHS in the year 2012.

Estigma, medo e perigo: representações sociais de usuários e/ou traficantes de drogas acometidos por tuberculose e profissionais de saúde na atenção básica

Resumo Este artigo apresenta e discute dados de uma pesquisa realizada nas comunidades de Manguinhos, município do Rio de Janeiro, sobre o tratamento da tuberculose no contexto de violência urbana. Para isso, toma-se como base as teorias das ciências sociais e humanas. O estudo aborda as representações sociais que influíram na interação entre os atores envolvidos nesse processo, profissionais de saúde e doentes acometidos por tuberculose e usuários e/ou traficantes de drogas, como resultado de construções históricas e contradições sociais determinadas pelo contexto social de violência em que estavam inseridos. O método da pesquisa foi qualitativo, com entrevistas semidiretivas que seguiram um roteiro etnográfico. A interpretação das respostas buscou significados a partir de categorias temáticas, visando sua articulação em categorias mais amplas. Os achados revelaram que as interações entre os usuários e os profissionais de saúde eram determinadas pela forma de perigo, medo e estigma em relação à tuberculose e violência.

Determinants of tuberculosis transmission and treatment abandonment in Fortaleza, Brazil

Background

Tuberculosis (TB) remains a public health problem, despite recent achievements in reducing incidence and mortality rates. In Brazil, these achievements were above the worldwide average, but marked by large regional heterogeneities. In Fortaleza (5th largest city in Brazil), the tuberculosis cure rate has been declining and treatment abandonment has been increasing in the past decade, despite a reduction in incidence and an increase in directly observed therapy (DOT). These trends put efforts to eliminate tuberculosis at risk. We therefore sought to determine social and programmatic determinants of tuberculosis incidence and treatment abandonment in Fortaleza.

Methods

We analyzed sociodemographic and clinical data for all new tuberculosis cases notified in the Notifiable Diseases Information System (SINAN) from Fortaleza between 2007 and 2014. We calculated incidence rates for 117 neighborhoods in Fortaleza, assessed their spatial clustering, and used spatial regression models to quantify associations between neighborhood-level covariates and incidence rates. We used hierarchical logistic regression models to evaluate how individual- and neighborhood-level covariates predicted tuberculosis treatment abandonment.

Results

There were 12,338 new cases reported during the study period. Case rates across neighborhoods were significantly positively clustered in two low-income areas close to the city center. In an adjusted model, tuberculosis rates were significantly higher in neighborhoods with lower literacy, higher sewerage access and homicide rates, and a greater proportion of self-reported black residents. Treatment was abandoned in 1901 cases (15.4%), a rate that rose by 71% between 2007 and 2014. Abandonment was significantly associated with many individual sociodemographic and clinical factors. Notably, being recommended for DOT was protective for those who completed DOT, but associated with abandonment for those who did not.

Conclusion

Low socioeconomic status areas have higher tuberculosis rates, and low socioeconomic individuals have higher risk of treatment abandonment, in Fortaleza. Treatment abandonment rates are growing despite the advent of universal DOT recommendations in Brazil. Proactive social policies, and active contact tracing to find missed cases, may help reduce the tuberculosis burden in this setting.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4435-0) contains supplementary material, which is available to authorized users.

Epidemiological, clinical and evolutionary aspects of tuberculosis among elderly patients of a university hospital in Belém, Pará

Abstract Objective: To evaluate the epidemiological, clinical and evolutionary aspects of tuberculosis in elderly patients of a university hospital in Belém, Pará. Method: A cross-sectional study was conducted in a university hospital, where 82 records of cases of tuberculosis in elderly patients were analyzed. The data was analyzed by applying the G-test, assuming a level of α=0.05 (5%) and a value of p=0.05. Results: Most of the elderly patients were male (64.6%), aged 60-69 years, especially among men (64.2%). Most were new cases of tuberculosis (95.1%), with a pulmonary clinical form (75.6%), associated diseases (69.5%) and a length of stay exceeding 21 days. Fever (67.1%), dyspnea (64.6%), weight loss (61.0%), productive cough (59.8%), chest pain (51.2%) were the main signs and symptoms. Regarding treatment, there was a high percentage of adverse reactions (50%), predominantly gastrointestinal events (70.7%). Most patients were cured (59.8%), but mortality from tuberculosis was considered high (15.9%). In terms of the exposure variables and outcome, there was a statistically significant difference for the age group (p=0.017), length of stay (p=0.000) and adverse reactions (p=0.018) only. Conclusion: The clinical presentation and therapeutic management of tuberculosis among the elderly has characteristics peculiar to this group, making it important to strengthen strategies that facilitate early identification of suspected cases of TB among elderly persons in the community, which should take place mainly through the primary care system.

Association between diabetes and tuberculosis: case-control study

OBJECTIVE

To test the association between diabetes and tuberculosis.

METHODS

It is a case-control study, matched by age and sex. We included 323 new cases of tuberculosis with positive results for bacilloscopy. The controls were 323 respiratory symptomatic patients with negative bacilloscopy, from the same health services, such as: ambulatory cases from three referral hospitals and six basic health units responsible for the notifications of new cases of tuberculosis in Salvador, Bahia. Data collection occurred between 2008 and 2010. The instruments used were structured interview, including clinical data, capillary blood glucose (during fasting or postprandial), and the CAGE questionnaire for screening of abusive consumption of alcohol. Descriptive, exploratory, and multivariate analysis was performed using conditional logistic regression.

RESULTS

The average age of the cases was 38.5 (SD = 14.2) years and of the controls, 38.5 (SD = 14.3) years. Among cases and controls, most subjects (61%) were male. In univariate analysis we found association between the occurrence of diabetes and tuberculosis (OR = 2.37; 95%CI 1.04-5.42), which remained statistically significant after adjustment for potential confounders (OR = 3.12; 95%CI 1.12-7.94).

CONCLUSIONS

The association between diabetes and tuberculosis can hinder the control of tuberculosis, contributing to the maintainance of the disease burden. The situation demands increasing early detection of diabetes among people with tuberculosis, in an attempt to improve disease control strategies.

OBJETIVO

Testar a associação entre diabetes e tuberculose.

MÉTODOS

Trata-se de estudo caso-controle, pareado por idade e sexo. Foram incluídos 323 casos novos de tuberculose com resultados positivos à baciloscopia. Os controles foram 323 sintomáticos respiratórios com baciloscopia negativa, oriundos dos mesmos serviços de saúde dos casos: ambulatórios de três hospitais de referência e seis unidades básicas de saúde responsáveis pelas notificações dos casos novos de tuberculose em Salvador, Bahia. A coleta de dados ocorreu entre 2008 e 2010. Os instrumentos utilizados foram entrevista estruturada, incluindo dados clínicos, glicemia capilar (em jejum ou pós-prandial) e o questionário CAGE para triagem de consumo abusivo de álcool. Foi realizada análise descritiva, exploratória e multivariada utilizando-se de regressão logística condicional.

RESULTADOS

A média de idade dos casos foi 38,5 (DP = 14,2) anos e dos controles, 38,5 (DP = 14,3) anos. Tanto entre os casos quanto entre os controles, a maioria (61%) dos indivíduos era do sexo masculino. Na análise univariada, houve associação entre ocorrência de diabetes e de tuberculose (OR = 2,37; IC95% 1,04-5,42), que permaneceu estatisticamente significante após ajuste pelos potenciais confundidores (OR = 3,12; IC95% 1,12-7,94).

CONCLUSÕES

A associação entre diabetes e tuberculose pode dificultar o controle da tuberculose, contribuindo para manutenção da elevada carga da doença. A situação demanda intensificação da detecção precoce de diabetes entre pessoas com tuberculose, na tentativa de maior efetividade das estratégias de controle da doença.

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends

Co-infection of tuberculosis (TB)-HIV/AIDS is a persistent public health problem in Brazil. This study describes epidemiological patterns and time trends of mortality related to TB-HIV/AIDS co-infection. Based on mortality data from 2000-2011 (almost 12.5 million deaths), 19,815 deaths related to co-infection were analyzed. The average age-adjusted mortality rate was 0.97 deaths/100,000 inhabitants. The highest mortality rates were found among males, those in economically productive age groups, black race/color and residents of the South region. There was a significant reduction in the mortality coefficient at the national level (annual average percent change: -1.7%; 95%CI: -2.4; -1.0), with different patterns among regions: increases in the North, Northeast and Central regions, a reduction in the Southeast and a stabilization in the South. The strategic integration of TB-HIV/AIDS control programmes is fundamental to reduce the burden of mortality related to co-infection in Brazil.

Differences in the clinical-epidemiological profile between new cases of tuberculosis and retreatment cases after default

Abstract OBJECTIVE To identify the socioeconomic and clinical-epidemiological factors related to tuberculosis in new cases and retreatment cases. METHOD Comparative study with 126 patients, of which 42 were retreatment cases after default attended in a reference center, and 84 were new cases completing the first treatment and treated in Basic Health Units. The collection of primary data was through interview, and of secondary data by records of the Notifiable Diseases Information System. Comparative analysis between the two groups. RESULTS The new cases differ from retreatment cases regarding educational level. The clinical-epidemiological profile shows a significant difference in relation to performance of the tuberculin skin test, and the HIV test result (positive) in favor of new cases. In relation to performance of sputum culture and the result (positive) of the first sputum smear of the first and second samples, in favor of retreatment cases. CONCLUSION The two groups are significantly different in clinical and epidemiological characteristics that show the access to exams.

Diagnosis of latent Mycobacterium tuberculosis infection: tuberculin test versus interferon-gamma release

INTRODUCTION

The treatment of individuals with active tuberculosis (TB) and the identification and treatment of latent tuberculosis infection (LTBI) contacts are the two most important strategies for the control of TB. The objective of this study was compare the performance of tuberculin skin testing (TST) with QuantiFERON-TB Gold In TUBE(r) in the diagnosis of LTBI in contacts of patients with active TB.

METHODS

Cross-sectional analytical study with 60 contacts of patients with active pulmonary TB. A blood sample of each contact was taken for interferon-gamma release assay (IGRA) and subsequently performed the TST. A receiver operating characteristic curve was generated to assess the cutoff points and the sensitivity, predictive values, and accuracy were calculated. The agreement between IGRA and TST results was evaluated by Kappa coefficient.

RESULTS

Here, 67.9% sensitivity, 84.4% specificity, 79.1% PPV, 75% NPV, and 76.7% accuracy were observed for the 5mm cutoff point. The prevalence of LTBI determined by TST and IGRA was 40% and 46.7%, respectively.

CONCLUSIONS

Both QuantiFERON-TB Gold In TUBE(r) and TST showed good performance in LTBI diagnosis. The creation of specific diagnostic methods is necessary for the diagnosis of LTBI with higher sensitivity and specificity, preferably with low cost and not require a return visit for reading because with early treatment of latent forms can prevent active TB.

TUBERCULOSIS CONTROL ACTIONS: ANALYSIS BASED ON THE ACCESS AND PRIMARY HEALTH CARE QUALITY IMPROVEMENT PROGRAM

ABSTRACT The study's aim was to analyze primary health care delivered to people with tuberculosis on a national level, based on the information collected by an external assessment implemented by the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica. This cross-sectional study with a quantitative approach used data from the 2nd cycle external assessment of the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica conducted in 2014. The Statistical Package for Social Sciences was used to establish frequencies and check for associations using the Chi-square test. The percentage of Family Health Strategy units recording the annual number of confirmed tuberculosis cases and respiratory symptoms was high for the entire country (81.1%). In contrast, the recording of follow-up of tuberculosis cases was performed by only 48.3% of the facilities, while only 48% of the health basic unites units implemented directly observed treatment. The findings reveal barriers in the structure of health basic unites units regarding the operationalization and sustainability of care provided to individuals with tuberculosis, including directly observed treatment.