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Natividade M, Pereira M, Stauber C, Miranda S, Teixeira MG, Souza RAD, Anjos MSD, Barros R, Morato DG, Aragão E, Pereira SM, Costa MDCN. Impact of the improvement of living conditions on tuberculosis mortality in Brazil: an ecological study. SAO PAULO MED J 2024; 142:e2023279. [PMID: 39194067 PMCID: PMC11364171 DOI: 10.1590/1516-3180.2023.0279.r1.13052024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/13/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking. OBJECTIVES To evaluate the impact of LC on TB mortality in Brazil. DESIGN AND SETTING This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015. METHODS Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure. RESULTS From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively. CONCLUSIONS Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.
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Affiliation(s)
- Marcio Natividade
- Adjunct Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Marcos Pereira
- Adjunct Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Christine Stauber
- Professor, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States
| | - Samilly Miranda
- Adjunct Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Maria Glória Teixeira
- Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Ramon Andrade de Souza
- Nurse, Postgraduate Program in Collective Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Marilia Santos Dos Anjos
- Nurse, Postgraduate Program in Collective Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Rafael Barros
- Adjunct Professor in Nursing School, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Daniela Gonçalves Morato
- Bachelor of Science in Biological Sciences, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Erika Aragão
- Associate Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Susan Martins Pereira
- Associate Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Maria da Conceição Nascimento Costa
- Associate Professor, Department of Public Health, Institute of Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
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Rasella D, Jesus G, Pinto P, Silva A, Cavalcanti D, Lua I, Ichihara M, Barreto M, Boccia D, Sanchez M. The effect of conditional cash transfers on tuberculosis incidence and mortality is determined by ethnoracial and socioeconomic factors: a cohort study of 54 million individuals in Brazil. RESEARCH SQUARE 2024:rs.3.rs-4272509. [PMID: 38746114 PMCID: PMC11092815 DOI: 10.21203/rs.3.rs-4272509/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Conditional Cash Transfers (CCT) are the world's most widely implemented interventions for poverty alleviation. Still, there is no solid evidence of the CCT effects on the reduction of the burden of Tuberculosis (TB) in marginalized and extremely vulnerable populations. We estimated the effect of the Bolsa Família Program (BFP), the largest CCT in the world, on TB incidence, mortality, and case-fatality rate using a nationwide cohort of 54.5 million individuals during a 12-year period in Brazil. Methods We selected low-income individuals who entered in the 100 Million Brazilians Cohort and were linked to nationwide TB registries between 2004 to 2015, and compared BFP beneficiaries and non-beneficiaries using a quasi-experimental impact evaluation design. We employed inverse probability of treatment weighting (IPTW) multivariable Poisson regressions, adjusted for all relevant socioeconomic, demographic, and healthcare confounding variables - at individual and municipal level. Subsequently, we evaluated BFP effects for different subpopulations according to ethnoracial factors, wealth levels, sex, and age. We also performed several sensitivity and triangulation analyses to verify the robustness of the estimates. Findings Exposure to BFP was associated with a large reduction in TB incidence in the low-income individuals under study (adjusted rate ratio [aRR]:0.59;95%CI:0.58-0.60) and mortality (aRR:0.69;95%CI:0.65-0.73). The strongest BFP effect was observed in Indigenous people both for TB incidence (aRR:0.37;95%CI:0.32-0.42), and mortality-aRR:0.35;95%CI:0.20-0.62), and in Black and Pardo people (Incidence-aRR:0.58;95%CI:0.57-0.59; Mortality -aRR:0.69;95%CI:0,64-0,73). BFP effects showed a clear gradient according to wealth levels and were considerably stronger among the extremely poor individuals for TB incidence (aRR:0.49, 95%CI:0.49-0.50) and mortality (aRR:0.60;95%CI:0.55-0.65). The BFP effects on case-fatality rates were also positive, however without statistical significance. Interpretation CCT can strongly reduce TB incidence and mortality in extremely poor, Indigenous, Black and Pardo populations, and could significantly contribute to achieving the End TB Strategy targets and the TB-related Sustainable Development Goals.
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Affiliation(s)
| | | | - Priscila Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA)
| | - Andréa Silva
- Institute of Collective Health, Federal University of Bahia; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvado
| | | | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ)
| | - Maria Ichihara
- The Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation (FIOCRUZ)
| | - Mauricio Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ)
| | - Delia Boccia
- Faculty of Population and Health Policy at London School of Hygiene and Tropical Medicine (LSHTM)
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Ferreira MRL, Bonfim RO, Bossonario PA, Maurin VP, Valença ABM, Abreu PDD, Andrade RLDP, Fronteira I, Monroe AA. Social protection as a right of people affected by tuberculosis: a scoping review and conceptual framework. Infect Dis Poverty 2023; 12:103. [PMID: 37993962 PMCID: PMC10664497 DOI: 10.1186/s40249-023-01157-1] [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: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Tuberculosis is an infectious disease strongly influenced by social determinants closely associated with cycles of poverty and social exclusion. Within this context, providing social protection for people affected by the disease constitutes a powerful instrument for reducing inequalities and enhancing inclusion and social justice. This study aimed to identify and synthesize strategies and measures aimed at ensuring social protection as a right of people affected by tuberculosis. METHODS This is a scoping review, with searches conducted in six databases in February 2023. We included publications from 2015 onwards that elucidate strategies and measures of social protection aimed at safeguarding the rights to health, nutrition, employment, income, housing, social assistance, and social security for people affected by tuberculosis. These strategies could be implemented through policies, programs, and/or governmental agreements in any given context. The data extracted from the articles underwent descriptive analysis and a narrative synthesis of findings based on the dimensions of social protection. Additionally, we developed a conceptual framework illustrating the organizational and operational aspects of measures and strategies related to each dimension of social protection identified in this review. RESULTS A total of 9317 publications were retrieved from the databases, of which sixty-three publications were included. The study's results highlighted measures and strategies concerning the social protection of people affected by tuberculosis. These measures and strategies revolved around the rights to proper nutrition and nourishment, income, housing, and health insurance, as well as expanded rights encompassing social assistance and social welfare. It was reported that ensuring these rights contributes to improving nutritional status and the quality of life for individuals with tuberculosis, along with reducing catastrophic costs, expanding access to healthcare interventions and services, and fostering TB treatment adherence, thereby leading to higher rates of TB cure. CONCLUSIONS Our findings identify social protection measures as a right for people affected by tuberculosis and have the potential to guide the development of evidence-based social and health policies through collaboration between tuberculosis control programs and governmental entities.
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Affiliation(s)
| | - Rafaele Oliveira Bonfim
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | | | - Paula Daniella de Abreu
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Inês Fronteira
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
- National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Aline Aparecida Monroe
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
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Ferreira-Batista NN, Teixeira AD, Diaz MDM, Postali FAS, Moreno-Serra R, Love-Koh J. Is primary health care worth it in the long run? Evidence from Brazil. HEALTH ECONOMICS 2023; 32:1504-1524. [PMID: 37010114 DOI: 10.1002/hec.4676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 06/04/2023]
Abstract
This paper assesses whether Brazilian primary health care is worth it in the long-run by estimating the accumulated costs and benefits of its flagship, the Family Health Strategy program (ESF). We employ an alternative strategy centered on years of exposure to the program to incorporate its dynamics. We also account for the program's heterogeneity with respect to the remuneration of ESF health teams and the intensity of coverage across Brazilian municipalities, measure by the number of people assisted by each ESF team, on average. To address heterogeneity in professional earnings, this paper employs, for the first time, a dataset containing the remuneration of professionals allocated to all ESF teams nationwide. The benefits are measured by the avoided deaths and hospitalizations due to causes sensitive to primary care. Results suggest that the net monetary benefit of the program is positive on average, with an optimum time of exposure of approximately 16 years. Significant heterogeneities in cost-benefit results were found since costs outweigh benefits in localities where the coverage is low intensive. On the other hand, the benefits outweigh the costs by 22.5% on average in municipalities with high intensive coverage.
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Affiliation(s)
| | | | | | | | | | - James Love-Koh
- Centre for Health Economics, University of York, York, UK
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Todd H, Hudson M, Grolmusova N, Kazibwe J, Pearman J, Skender K, Tran PB, Boccia D, Shete PB, Wingfield T. Social Protection Interventions for TB-Affected Households: A Scoping Review. Am J Trop Med Hyg 2023; 108:650-659. [PMID: 36806490 PMCID: PMC10076998 DOI: 10.4269/ajtmh.22-0470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/28/2022] [Indexed: 02/22/2023] Open
Abstract
Tuberculosis (TB) and poverty are inextricably linked. Catastrophic costs of TB illness drive TB-affected households into worsening impoverishment and hamper treatment success. The WHO's End TB Strategy recommends social protection for TB-affected households to mitigate financial shock and improve TB outcomes. This scoping review maps the landscape of social protection interventions for people with TB and their households in low- and middle-income countries with high TB burden. A systematic search of Medline, Embase, PubMed, and Web of Science for relevant articles was performed, supplemented with a gray literature search of key databases. Articles were included if they described social protection available to people with TB and TB-affected households in a low- or middle-income country. Data were synthesized in tabular form, and descriptive narrative outlined the successes and challenges of the social protection interventions identified. The search identified 33,360 articles. After abstract screening, 74 articles underwent full text screening, and 49 were included in the final analysis. Forty-three types of social protection were identified, of which 24 were TB specific (i.e., only people with TB were eligible). Varying definitions were used to describe similar social protection interventions, which limited cross-study comparison. Intervention successes included acceptability and increased financial autonomy among recipients. Challenges included delays in intervention delivery and unexpected additional bank transfer fees. A wide range of acceptable social protection interventions are available, with cash transfer schemes predominating. Use of standardized definitions of social protection interventions would facilitate consolidation of evidence and enhance design and implementation in future.
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Affiliation(s)
- Heather Todd
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Mollie Hudson
- School of Nursing, University of California San Francisco, San Francisco, California
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Natalia Grolmusova
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joseph Kazibwe
- London School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Joseph Pearman
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kristina Skender
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Phuong B. Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Delia Boccia
- London School of Hygiene and Tropical Medicine, Liverpool, United Kingdom
| | - Priya B. Shete
- Center for Tuberculosis University of California, San Francisco, San Francisco, California
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, San Francisco, California
| | - Tom Wingfield
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Global Public Health, World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Touchton M, Wampler B. Democratizing Public Health: Participatory Policymaking Institutions, Mosquito Control, and Zika in the Americas. Trop Med Infect Dis 2023; 8:tropicalmed8010038. [PMID: 36668945 PMCID: PMC9865320 DOI: 10.3390/tropicalmed8010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
The Zika virus is a mosquito-borne virus spread primarily by Aedes mosquitoes. Zika cases have been detected throughout the mosquito's range, with an epidemic occurring from 2015 to 2017 in Brazil. Many Zika cases are mild or asymptomatic, but infections in pregnant women can cause microcephaly in children, and a small percentage of cases result in Guillan-Barré syndrome. There is currently little systematic information surrounding the municipal spread of the Zika Virus in Brazil. This article uses coarsened exact matching with negative binomial estimation and ordinary least squares estimation to assess the determinants of Zika incidence across the ~280,000 cases confirmed and recorded by Brazil's Ministry of Health in 2016 and 2017. These data come from Freedom of Information Act (FOIA) requests in Brazil and have not been published. We use data on the universe of individual Zika cases in Brazil and Geographic Information Systems (GIS) software to examine the virus at the municipal level across 5570 municipalities and construct a unique, unusually rich dataset covering daily Zika transmission. Additionally, our dataset includes corresponding local data on democratic governance, mosquito control efforts, and environmental conditions to estimate their relationship to Zika transmission. The results demonstrate that the presence of subnational democratic, participatory policymaking institutions and high levels of local state capacity are associated with low rates of Zika contraction. These models control for local healthcare spending and economic conditions, among other factors, that also influence Zika contraction rates. In turn, these findings provide a better understanding of what works for local health governance and mosquito control and makes important data public so that scholars and practitioners can perform their own analyses. Stronger models of Zika transmission will then inform mosquito abatement efforts across the Global South, as well as provide a blueprint for combatting Dengue fever, which is also transmitted by Aedes mosquitoes.
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Affiliation(s)
- Michael Touchton
- Department of Political Science, University of Miami, Coral Gables, FL 33146, USA
- Faculty Lead for Global Health, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL 33146, USA
- Correspondence:
| | - Brian Wampler
- President’s Office of Public Engagement, Boise State University, Boise, ID 83725, USA
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Robust evidence of Bolsa Família Programme's benefits. THE LANCET HIV 2022; 9:e669-e670. [DOI: 10.1016/s2352-3018(22)00245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/20/2022]
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Mullachery PH, Macinko J. The authors reply. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00010422. [PMID: 35544914 DOI: 10.1590/0102-311x00010422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
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Jesus GS, Pescarini JM, Silva AF, Torrens A, Carvalho WM, Junior EPP, Ichihara MY, Barreto ML, Rebouças P, Macinko J, Sanchez M, Rasella D. The effect of primary health care on tuberculosis in a nationwide cohort of 7·3 million Brazilian people: a quasi-experimental study. Lancet Glob Health 2022; 10:e390-e397. [PMID: 35085514 PMCID: PMC8847211 DOI: 10.1016/s2214-109x(21)00550-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Universal health coverage is one of the WHO End TB Strategy priority interventions and could be achieved-particularly in low-income and middle-income countries-through the expansion of primary health care. We evaluated the effects of one of the largest primary health-care programmes in the world, the Brazilian Family Health Strategy (FHS), on tuberculosis morbidity and mortality using a nationwide cohort of 7·3 million individuals over a 10-year study period. METHODS We analysed individuals who entered the 100 Million Brazilians Cohort during the period Jan 1, 2004, to Dec 31, 2013, and compared residents in municipalities with no FHS coverage with residents in municipalities with full FHS coverage. We used a cohort design with multivariable Poisson regressions, adjusted for all relevant demographic and socioeconomic variables and weighted with inverse probability of treatment weighting, to estimate the effect of FHS on tuberculosis incidence, mortality, cure, and case fatality. We also performed a range of stratifications and sensitivity analyses. FINDINGS FHS exposure was associated with lower tuberculosis incidence (rate ratio [RR] 0·78, 95% CI 0·72-0·84) and mortality (0·72, 0·55-0·94), and was positively associated with tuberculosis cure rates (1·04, 1·00-1·08). FHS was also associated with a decrease in tuberculosis case-fatality rates, although this was not statistically significant (RR 0·84, 95% CI 0·55-1·30). FHS associations were stronger among the poorest individuals for all the tuberculosis indicators. INTERPRETATION Community-based primary health care could strongly reduce tuberculosis morbidity and mortality and decrease the unequal distribution of the tuberculosis burden in the most vulnerable populations. During the current marked rise in global poverty due to the COVID-19 pandemic, investments in primary health care could help protect against the expected increases in tuberculosis incidence worldwide and contribute to the attainment of the End TB Strategy goals. FUNDING TB Modelling and Analysis Consortium (Bill & Melinda Gates Foundation), Wellcome Trust, and Brazilian Ministry of Health. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Gabriela S Jesus
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil; Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Julia M Pescarini
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Andrea F Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Ana Torrens
- Vital Strategies, Civil Registration and Vital Statistics Improvement and Data Impact Programs, São Paulo, Brazil
| | | | - Elzo P P Junior
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maria Y Ichihara
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mauricio L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Poliana Rebouças
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Mauro Sanchez
- Department of Public Health, University of Brasilia, Brasilia, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; ISGlobal, Hospital Clínic- Universitat de Barcelona, Barcelona, Spain.
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Pelissari DM, Oliveira PB. Universal health coverage: an effective intervention for a tuberculosis-free world. Lancet Glob Health 2022; 10:e309-e310. [PMID: 35085513 PMCID: PMC8786318 DOI: 10.1016/s2214-109x(21)00564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Daniele Maria Pelissari
- National Tuberculosis Control Program, Health Surveillance Secretariat, Ministry of Health, Brasilia, Brazil.
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Diaz MDM, Teixeira AD, Postali FAS, Ferreira-Batista NN, Moreno-Serra R. Assessment of the Association between the Brazilian Family Health Strategy and Adult Mortality. Health Policy Plan 2022; 37:461-471. [DOI: 10.1093/heapol/czac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct association of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25–64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discussed heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension, and diabetes.. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasise the role of having sufficient health teams to attend to the population.
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Postali FAS, Diaz MDM, Ferreira-Batista NN, Teixeira AD, Moreno-Serra R. Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil. BMC Health Serv Res 2021; 21:1300. [PMID: 34863160 PMCID: PMC8642960 DOI: 10.1186/s12913-021-07329-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. Methods The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. Results Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. Conclusions The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07329-9.
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Affiliation(s)
| | - Maria Dolores Montoya Diaz
- Department of Economics, University of Sao Paulo, Avenida Prof. Luciano Gualberto, 908, São Paulo, SP, 5508-010, Brazil
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Röding D, Walter U, Dreier M. Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data. J Urban Health 2021; 98:791-800. [PMID: 34799821 PMCID: PMC8688653 DOI: 10.1007/s11524-021-00590-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/28/2022]
Abstract
Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998-2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = - 2.48 (95% CI - 3.45 to - 1.51) for IG vs. CG and b = - 0.30 (95% CI - 0.46 to - 0.14) for ISCHP duration (0-16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.
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Affiliation(s)
- Dominik Röding
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Ulla Walter
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Maren Dreier
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
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Chenciner L, Annerstedt KS, Pescarini JM, Wingfield T. Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study. Lancet Glob Health 2021; 9:e1380-e1390. [PMID: 34534486 DOI: 10.1016/s2214-109x(21)00300-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Tuberculosis elimination strategies in Brazil might neglect adolescents and young adults aged 10-24 years, hampering tuberculosis control. However, little is known about factors associated with tuberculosis treatment outcomes in this underserved group. In this study, we aimed to investigate social and health factors associated with unfavourable treatment outcomes in young people with tuberculosis in Brazil. METHODS A national retrospective cohort study was done using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil. People aged 10-24 years (young people) with tuberculosis registered in SINAN between Jan 1, 2015, and Dec 31, 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, and death. Favourable outcome was defined as treatment success. Multiple logistic regression models estimated the association between social and health factors and tuberculosis treatment outcomes. FINDINGS 67 360 young people with tuberculosis were notified to SINAN, and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes. Young people who received government cash transfers were less likely to have an unfavourable outcome (adjusted odds ratio 0·83, 95% CI 0·70-0·99). Homelessness (3·03, 2·07-4·42), HIV (2·89, 2·45-3·40), and illicit drug use (2·22, 1·93-2·55) were the main factors associated with unfavourable treatment outcome. INTERPRETATION In this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes. FUNDING Wellcome Trust, UK Medical Research Council, and UK Foreign Commonwealth and Development Office.
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Affiliation(s)
- Louisa Chenciner
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden.
| | - Kristi Sidney Annerstedt
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden
| | - Julia M Pescarini
- Centre for Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Wingfield
- Department of Global Public Health, WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Solna, Sweden; Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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15
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Dousa KM, Kurz SG, Bark CM, Bonomo RA, Furin JJ. Drug-Resistant Tuberculosis: A Glance at Progress and Global Challenges. Infect Dis Clin North Am 2020; 34:863-886. [PMID: 33011048 DOI: 10.1016/j.idc.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multidrug-resistant Mycobacterium tuberculosis remains a major public health threat; its management poses a significant economic burden. Treatment requires a programmatic approach with access to laboratory services, second-line medications, and adequate clinical resources. In recent years, we have seen rapid developments in diagnostic techniques with whole genome sequencing-based drug susceptibility prediction now in reach, an array of new drugs that transform treatment regimens to purely oral formulations, and a steady stream of multinational trials that inform us about most efficient combinations. Our hope is that the current momentum keeps the ambitious goal to end tuberculosis in 2030 in reach.
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Affiliation(s)
- Khalid M Dousa
- Division of Infectious Diseases & HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Sebastian G Kurz
- Mount Sinai National Jewish Health Respiratory Institute, 10 East 102nd Street, New York City, NY 10029, USA
| | - Charles M Bark
- Division of Infectious Diseases, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Department of Pharmacology, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Department of Biochemistry, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Medical Service and GRECC, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
| | - Jennifer J Furin
- Division of Infectious Diseases & HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.
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16
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de Paula Martins L, Trevisol DJ, Schuelter-Trevisol F. Effect of the Bolsa Familia Programme on tuberculosis treatment outcomes. LANCET GLOBAL HEALTH 2020; 7:e565. [PMID: 31000126 DOI: 10.1016/s2214-109x(19)30152-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Leonardo de Paula Martins
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil
| | - Daisson José Trevisol
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil
| | - Fabiana Schuelter-Trevisol
- Postgraduate Programme in Health Sciences, University of Southern Santa Catarina, Tubarão 88704-900, Brazil.
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17
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Boing A, Boing A, Wagner K, Subramanian S. Narrowing geographic inequality in life expectancy in Brazil: a multilevel analysis between 1991 and 2010. Public Health 2020; 180:102-108. [DOI: 10.1016/j.puhe.2019.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/19/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
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18
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Furin J, Loveday M, Hlangu S, Dickson-Hall L, le Roux S, Nicol M, Cox H. "A very humiliating illness": a qualitative study of patient-centered Care for Rifampicin-Resistant Tuberculosis in South Africa. BMC Public Health 2020; 20:76. [PMID: 31952494 PMCID: PMC6969445 DOI: 10.1186/s12889-019-8035-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient-centered care is pillar 1 of the "End TB" strategy, but little has been documented in the literature about what this means for people living with rifampicin-resistant (RR-TB). Optimizing care for such individuals requires a better understanding of the challenges they face and the support they need. METHODS A qualitative study was done among persons living with RR-TB and members of their support network. A purposive sample was selected from a larger study population and open-ended interviews were conducted using a semi-standard interview guide. Interviews were recorded and transcribed and the content analyzed using an iterative thematic analysis based in grounded theory. RESULTS 16 participants were interviewed from three different provinces. Four distinct periods in which support was needed were identified: 1) pre-diagnosis; 2) pre-treatment; 3) treatment; and 4) post-treatment. Challenges common in all four periods included: socioeconomic issues, centralized care, and the need for better counseling at multiple levels. CONCLUSIONS Beyond being a "very humiliating illness", RR-TB robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered. Efforts to tackle these issues are as important as new drugs and diagnostics in the fight against TB.
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Affiliation(s)
- Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
| | - Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sindisiwe Hlangu
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lindy Dickson-Hall
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
| | - Sacha le Roux
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
| | - Mark Nicol
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Helen Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
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19
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Leite TH, Moraes CLD, Marques ES, Caetano R, Braga JU, Reichenheim ME. Women economic empowerment via cash transfer and microcredit programs is enough to decrease intimate partner violence? Evidence from a systematic review. CAD SAUDE PUBLICA 2019; 35:e00174818. [PMID: 31508698 DOI: 10.1590/0102-311x00174818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/16/2019] [Indexed: 11/21/2022] Open
Abstract
Intimate partner violence (IPV) is a worldwide public health problem. Many proposals aiming to eliminate its occurrence include the empowerment of women through their socio-economic development. In this context, some studies suggested that microcredit programs (MP) and cash transfer programs (CTP) are initiatives that can also reduce the risk of IPV. Others pointed to an opposite effect. The objective of this study was to investigate the influence of women's economic empowerment in MP and CTP on the risk of physical, psychological and sexual violence through a systematic review. Papers/documents selection was conducted by two researchers according to the following criteria: published in English, Portuguese or Spanish; primary data; assessing the effect of MP or CTP on IPV; in heterosexual couples; on women beneficiaries of the intervention; using a comparator group eligible for an MP or CTP; and focusing on risk IPV as the outcomes. Our results showed that the impact of MP are mixed when it comes to physical and physical/sexual violence. Even so, the review suggests that the effect of MP on sexual violence is trivial or nonexistent. Regarding the impact of CTPs, the present study showed that the effects on physical, physical/sexual, psychological, and sexual violence were also heterogeneous. Women more empowered and with some autonomy could be at risk. Despite that, participation in the empowerment program should be encouraged for poor women and families. However, parallel interventions to lead with IPV should be addressed to the main actions to reduce the risk of increasing IPV prevalence in certain scenarios.
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20
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Gomes MGM, Oliveira JF, Bertolde A, Ayabina D, Nguyen TA, Maciel EL, Duarte R, Nguyen BH, Shete PB, Lienhardt C. Introducing risk inequality metrics in tuberculosis policy development. Nat Commun 2019; 10:2480. [PMID: 31171791 PMCID: PMC6554307 DOI: 10.1038/s41467-019-10447-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Global stakeholders including the World Health Organization rely on predictive models for developing strategies and setting targets for tuberculosis care and control programs. Failure to account for variation in individual risk leads to substantial biases that impair data interpretation and policy decisions. Anticipated impediments to estimating heterogeneity for each parameter are discouraging despite considerable technical progress in recent years. Here we identify acquisition of infection as the single process where heterogeneity most fundamentally impacts model outputs, due to selection imposed by dynamic forces of infection. We introduce concrete metrics of risk inequality, demonstrate their utility in mathematical models, and pack the information into a risk inequality coefficient (RIC) which can be calculated and reported by national tuberculosis programs for use in policy development and modeling. Failure to account for heterogeneity in TB risk can mislead model-based evaluation of proposed interventions. Here, the authors introduce a metric to estimate the distribution of risk in populations from routinely collected data and find that variation in infection acquisition is the most impactful.
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Affiliation(s)
- M Gabriela M Gomes
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom. .,CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, 4485-661, Portugal.
| | - Juliane F Oliveira
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, 4485-661, Portugal
| | - Adelmo Bertolde
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, 29075-910, Brazil
| | - Diepreye Ayabina
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, United Kingdom
| | | | - Ethel L Maciel
- Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, 29047-105, Brazil
| | - Raquel Duarte
- Faculdade de Medicina, and EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, 4050-091, Portugal
| | | | - Priya B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Christian Lienhardt
- Global TB Programme, World Health Organization, 1211 Geneva 27, Geneva, Switzerland.,Unité Mixte Internationale TransVIHMI (UMI 233 IRD - U1175 INSERM - Université de Montpellier), Institut de Recherche pour le Développement (IRD), Montpellier, 34394, France
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21
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Abstract
Tuberculosis remains the leading cause of death from an infectious disease among adults worldwide, with more than 10 million people becoming newly sick from tuberculosis each year. Advances in diagnosis, including the use of rapid molecular testing and whole-genome sequencing in both sputum and non-sputum samples, could change this situation. Although little has changed in the treatment of drug-susceptible tuberculosis, data on increased efficacy with new and repurposed drugs have led WHO to recommend all-oral therapy for drug-resistant tuberculosis for the first time ever in 2018. Studies have shown that shorter latent tuberculosis prevention regimens containing rifampicin or rifapentine are as effective as longer, isoniazid-based regimens, and there is a promising vaccine candidate to prevent the progression of infection to the disease. But new tools alone are not sufficient. Advances must be made in providing high-quality, people-centred care for tuberculosis. Renewed political will, coupled with improved access to quality care, could relegate the morbidity, mortality, and stigma long associated with tuberculosis, to the past.
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Affiliation(s)
- Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Helen Cox
- Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Madhukar Pai
- McGill International Tuberculosis Centre, McGill University, Montreal, QC, Canada; Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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22
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Reis-Santos B, Shete P, Bertolde A, Sales CM, Sanchez MN, Arakaki-Sanchez D, Andrade KB, Gomes MGM, Boccia D, Lienhardt C, Maciel EL. Tuberculosis in Brazil and cash transfer programs: A longitudinal database study of the effect of cash transfer on cure rates. PLoS One 2019; 14:e0212617. [PMID: 30794615 PMCID: PMC6386534 DOI: 10.1371/journal.pone.0212617] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 02/06/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction Tuberculosis incidence is disproportionately high among people in poverty. Cash transfer programs have become an important strategy in Brazil fight inequalities as part of comprehensive poverty alleviation policies. This study was aimed at assessing the effect of being a beneficiary of a governmental cash transfer program on tuberculosis (TB) treatment cure rates. Methods We conducted a longitudinal database study including people ≥18 years old with confirmed incident TB in Brazil in 2015. We treated missing data with multiple imputation. Poisson regression models with robust variance were carried out to assess the effect of TB determinants on cure rates. The average effect of being beneficiary of cash transfer was estimated by propensity-score matching. Results In 2015, 25,084 women and men diagnosed as new tuberculosis case, of whom 1,714 (6.8%) were beneficiaries of a national cash transfer. Among the total population with pulmonary tuberculosis several determinants were associated with cure rates. However, among the cash transfer group, this association was vanished in males, blacks, region of residence, and people not deprived of their freedom and who smoke tobacco. The average treatment effect of cash transfers on TB cure rates, based on propensity score matching, found that being beneficiary of cash transfer improved TB cure rates by 8% [Coefficient 0.08 (95% confidence interval 0.06–0.11) in subjects with pulmonary TB]. Conclusion Our study suggests that, in Brazil, the effect of cash transfer on the outcome of TB treatment may be achieved by the indirect effect of other determinants. Also, these results suggest the direct effect of being beneficiary of cash transfer on improving TB cure rates.
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Affiliation(s)
- Barbara Reis-Santos
- Laboratory of Epidemiology of Federal University of Espírito Santo, Vitória/ES, Brazil
- * E-mail:
| | - Priya Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Adelmo Bertolde
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória/ES, Brazil
| | - Carolina M. Sales
- Laboratory of Epidemiology of Federal University of Espírito Santo, Vitória/ES, Brazil
| | - Mauro N. Sanchez
- Departamento de Saúde Coletiva, Universidade de Brasília: Asa Norte, Brasília/DF, Brazil
| | | | - Kleydson B. Andrade
- Programa Nacional de Controle da Tuberculose—Ministério da Saúde, Brasília/DF, Brazil
| | - M. Gabriela M. Gomes
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Vairão, Portugal
| | - Delia Boccia
- London School of Hygiene and Tropical Medicine: Keppel St., Bloomsbury, London, United Kingdom
| | - Christian Lienhardt
- Global TB Programme, World Health Organisation, Geneva, Switzerland
- Unité Mixte Internationale TransVIHMI (UMI 233 IRD–U1175 INSERM—Université de Montpellier), Institut de Recherche pour le Développement, Montpellier, France
| | - Ethel L. Maciel
- Laboratory of Epidemiology of Federal University of Espírito Santo, Vitória/ES, Brazil
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Furin J. Advances in the diagnosis, treatment, and prevention of tuberculosis in children. Expert Rev Respir Med 2019; 13:301-311. [PMID: 30648437 DOI: 10.1080/17476348.2019.1569518] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pediatric tuberculosis (TB) is a significant global health threat and is one of the top ten causes of death in children. There are a number of diagnostic, treatment, and preventive innovations that have been developed in the last decade for TB, however, these are out of reach for many children in the world. Areas covered: A comprehensive review of the literature on TB in children was done using PubMed and Ovid databases from 1 January 1996 up to 31 October 2018. Topic areas covered included diagnosis of TB, treatment of TB (including novel medications and regimens), prevention of DR-TB, and support to achieve the best possible outcomes. Each of these areas are explored in more detail in the paper. Expert commentary: There is great potential for radical changes in the way all forms of TB are diagnosed, treated and prevented in children. If there is continued advocacy and adequate funding and accountability, it could be possible to make great strides toward eliminating TB in children in the next ten years.
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Affiliation(s)
- Jennifer Furin
- a Harvard Medical School , Department of Global Health and Social Medicine , Boston , MA , USA
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Machado DB, Rodrigues LC, Rasella D, Lima Barreto M, Araya R. Conditional cash transfer programme: Impact on homicide rates and hospitalisations from violence in Brazil. PLoS One 2018; 13:e0208925. [PMID: 30596664 PMCID: PMC6312285 DOI: 10.1371/journal.pone.0208925] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Homicide kills more people than war globally and is associated with income inequality. In Brazil, one of the most unequal countries of the world, the homicide rate is four times higher than the world average. Establishing if the Brazilian conditional cash transfer programme [Bolsa Familia Programme (BFP)], the largest in the world, is associated with a reduction in the rate of homicide is relevant for violence prevention programs. We aimed to assess the effect of BFP coverage on homicide and hospitalization rates from violence. METHODS BFP coverage and rates of homicide (overall and disaggregated by sex and age) and hospitalizations from violence from all 5,507 Brazilian municipalities between 2004 and 2012 were explored using multivariable negative binomial regression models with fixed effect for panel data. Robustness of results was explored using sensitivity analyses such as difference-in-difference models. FINDINGS Homicide rates and hospitalization from violence decreased as BFP coverage in the target population increased. For each percent increase in the uptake of the BFP, the homicide rate decreased by 0.3% (Rate Ratio:0.997; 95%CI:0.996-0.997) and hospitalizations from violence by 0.4% (RR: 0.996;95%CI:0.995-0.996). Rates of homicide and hospitalizations from violence were also negatively associated with the duration of BFP coverage. When, coverage of the target population was at least 70% for one-year, hospitalizations from violence decreased by 8%; two-years 14%, three-years 20%, and four years 25%. INTERPRETATION Our results support the hypothesis that conditional cash transfer programs might have as an additional benefit the prevention of homicides and hospitalizations from violence. Social protection interventions could contribute to decrease levels of violence in low-and-middle-income-countries through reducing poverty and/or socioeconomic inequalities.
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Affiliation(s)
- Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Bahia, Brazil
- Centre for Global Mental Health (LSHTM), London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Davide Rasella
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Bahia, Brazil
| | - Maurício Lima Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Salvador, Bahia, Brazil
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