Fatores relacionados, tendência temporal e associação espacial do abandono de tratamento para tuberculose em Ribeirão Preto-SP / Related factors, time trend and spatial association of abandonment of treatment for tuberculosis in Ribeirão Preto-SP

Objetivou-se identificar fatores relacionados, classificar a tendência temporal e identificar áreas com associação espacial do abandono de tratamento para tuberculose em Ribeirão Preto, São Paulo. Estudo ecológico; população composta pelos casos notificados entre 2006 a 2017. Realizou-se o teste qui-quadrado para identificar fatores relacionados. Para a tendência temporal, utilizou-se o método de Prais-Winsten para classificar a tendência temporal do evento e calculada sua porcentagem de variação anual. Para verificar associação espacial, utilizaram-se as técnicas G e Gi*. Foram notificados 146 casos de abandono do tratamento da doença no período; como fatores de risco foi identificado pessoas sem escolaridade, retratamentos pós-abandono e falência prévia; como proteção casos novos identificados pela busca ativa, não ter coinfecção Tuberculose-HIV e não fazer uso de álcool ou drogas. A taxa de abandono apresenta tendência crescente (APC=1,6%; IC95% 0.02­3.48). O estudo evidencia o aumento do abandono de tratamento, contrariando as políticas direcionadas pelo End TB Strategy.

The objective was to identify related factors, classify the time trend and identify areas with spatial association of abandonment of treatment for tuberculosis in Ribeirão Preto, São Paulo. Ecological study; population composed of the cases notified between 2006 and 2017. The chi-square test was performed to identify related factors. For the time trend, the Prais-Winsten method was used to classify the time trend of the event and calculate its percentage of annual variation. To verify spatial association the G and Gi* techniques were used. In the period, 146 cases of abandonment of the disease treatment were notified; as risk factors, people without education, retreatment after abandonment, and previous failure were identified; as protection, new cases were identified by active search, no Tuberculosis-HIV co-infection, and no alcohol or drug use. The abandonment rate shows an increasing trend (APC=1.6%; 95%CI 0.02­3.48). The study evidences the increase of abandonment of treatment, contradicting the policies directed by the End TB Strategy.

Adherence to anti-tuberculosis treatment among patients in urban field practice area of medical college, Davangere, Karnataka: a qualitative study

Background: Despite effective diagnosis and free treatment, prevalence of TB is still growing. DOTS was introduced by WHO in 1997, which is more than two decades ago. It’s a known fact in TB that adherence is less due to long duration of treatment and stigma associated with it. This study was conducted with the objective of estimating and the reasons for the non- adherence to anti tuberculosis treatment in urban field practice area of SSIMS & RC, Davangere.Methods: A qualitative method of study design was used. 20 TB patients who are on anti-tuberculosis treatment were interviewed with a structured questionnaire for adherence to treatment. Among them patients who were non adherent were further interviewed in depth to know the reasons for non-adherence.Results: Data analysis resulted in extraction of five themes, which were side effects, financial burden and social support, duration of treatment, food insecurity, unawareness of consequences of non-adherence to treatment.Conclusions: Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of non-adherence to treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, motivational counselling, social, family support for patients and improving awareness about disease