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1.
Interface (Botucatu, Online) ; 24: e190160, 2020.
Article in Portuguese | LILACS (Americas) | ID: biblio-1040195

ABSTRACT

O presente artigo discute a descentralização do Tratamento Diretamente Observado (TDO) da tuberculose (TB) em um município da região metropolitana de Porto Alegre, RS. Após a implementação da estratégia, as taxas de abandono do tratamento diminuíram, mas o município não alcançou a meta preconizada pela Organização Mundial de Saúde (OMS). Trata-se de uma pesquisa qualitativa que entrevistou profissionais da atenção primária e da vigilância em saúde. Os resultados apontaram que a descentralização apenas do procedimento pode significar somente o acréscimo de mais uma tarefa para a atenção primária e alimentar a compreensão de uma responsabilidade parcial, não coerente com esse nível de atenção. Como possibilidade para diminuir o abandono, sugere-se a descentralização completa do cuidado para atenção primária e a constituição de apoio matricial que envolva profissionais especializados e o núcleo de vigilância.(AU)


Abstract This article addresses decentralization of Directly Observed Therapy (DOT) for treating tuberculosis (TB) in a Brazilian city in the metropolitan region of Porto Alegre, state of Rio Grande do Sul. After implementing the strategy, treatment dropout rates decreased, but the city has not achieved the goal recommended by the World Health Organization (WHO). This qualitative research was conducted through interviews with primary care and health surveillance professionals. The results showed that decentralizing the procedure can mean adding another task to primary care and can base the understanding of a partial responsibility that is not coherent with this level of care. As a possibility to reduce dropout, we suggest a complete decentralization of primary health care and the constitution of a matrix support involving specialized professionals and the surveillance center.(AU)


Resumen El artículo discute la descentralización del Tratamiento Directamente Observado (TDO) de la tuberculosis en un municipio de la región metropolitana de Porto Alegre/Estado de Rio Grande do Sul. Después de la implementación de la estrategia, las tasas de abandono del tratamiento disminuyeron, pero el municipio no alcanzó la meta determinada por la OMS. Encuesta cualitativa que entrevistó a profesionales de la atención primaria y de la vigilancia en salud. Los resultados señalaron que la descentralización únicamente del procedimiento puede significar tan solo añadir una tarea más a la atención primaria y alimentar la comprensión de una responsabilidad parcial no coherente con ese tipo de atención. Como una posibilidad de disminuir el abandono se sugiere la descentralización completa del cuidado para la atención primaria y la construcción de apoyo matricial que envuelva a profesionales especializados y el núcleo de vigilancia.(AU)


Subject(s)
Humans , Primary Health Care , Tuberculosis/therapy , Directly Observed Therapy/methods , Treatment Outcome , Public Health Surveillance , Treatment Adherence and Compliance/statistics & numerical data
2.
Ciênc. saúde coletiva ; 22(6): 1969-1977, jun. 2017. tab
Article in Portuguese | LILACS (Americas) | ID: biblio-839997

ABSTRACT

Resumo O objetivo deste artigo é analisar fontes de registro da tuberculose (TB) antes e após a implantação do Sistema Informatizado para Registro da Assistência à TB em Ribeirão Preto (SP). Estudo epidemiológico descritivo-analítico, do tipo intervenção. Os dados foram coletados em fontes secundárias, a partir de um formulário estruturado, e analisados através de teste Qui-quadrado ou Exato de Fisher com nível de significância de 5%. Identificou-se associação entre o período anterior da implantação do sistema com o arquivamento da Ficha do Tratamento Diretamente Observado no prontuário e o registro de orientação de retorno às consultas pela equipe de enfermagem. O posterior esteve associado com o aumento do registro do contato telefônico e endereço do doente de TB, data de término do tratamento, situação de encerramento, resultado da baciloscopia de escarro para controle mensal, teste anti-HIV, consultas mensais e solicitação de exames realizados pelo médico, atendimento com assistente social, condições de vida do doente, controle de comunicantes, incentivos sociais e uso de álcool e drogas. A implantação do sistema possibilitou a melhora no registro de algumas variáveis, ainda que outras fontes de registro tenham permanecido que não fossem o próprio sistema.


Abstract Objective to analyze sources of data for tuberculosis (TB) before and after the implementation of the Computerized System to Record Care for TB in Ribeirão Preto - SP. Method Intervention, descriptive-analytical epidemiological study. Data was collected from secondary sources using a structured form, and analyzed using Chi-squared or Fisher’s Exact Test, with a significance level of 5%. Results We found an association between the period before implementation of the system and placing the Directly Observed Treatment Card in the file, and registration of instructions for the return visit by the nursing team. The latter was associated with an increase in registered data regarding TB patient telephone number, address, end of treatment date, status at closing, sputum smear results for monthly control, HIV test, monthly checkups, tests ordered by physician, social worker visits, patient living conditions, contact control, social incentives and the use of drugs and alcohol. Conclusion Implementing the system improved the registration of a number of variables, despite the fact that other sources of data other than the system continue to exist.


Subject(s)
Humans , Delivery of Health Care/methods , Directly Observed Therapy/methods , Health Information Systems , Tuberculosis/therapy , Antitubercular Agents/administration & dosage , Brazil
3.
Clinics ; 70(6): 429-434, 06/2015. tab, graf
Article in English | LILACS (Americas) | ID: lil-749788

ABSTRACT

OBJECTIVES: Fixed-dose combination formulations, which simplify the administration of drugs and prevent the development of drug resistance, have been recommended as a standard anti-tuberculosis treatment regimen. However, the composition and dosage recommendations for fixed-dose combination formulations differ from those for separate formulations. Thus, questions about the effectiveness and side effects of combination formulations remain. The aim of this study was to compare the safety and efficacy of these two types of anti-tuberculosis regimens for pulmonary tuberculosis treatment. METHOD: A prospective, randomized controlled study was conducted using the directly observed treatment short-course strategy. Patients were randomly allocated to one of two short-course regimens. One year after completing the treatment, these patients’ outcomes were analyzed. ClinicalTrials.gov: NCT00979290. RESULTS: A total of 161 patients were enrolled, 142 of whom were evaluable for safety assessment. The two regimens had a similar incidence of adverse effects. In the per-protocol population, serum bilirubin concentrations at the peak level, at week 4, and at week 8 were significantly higher for the fixed-dose combination formulation than for the separate formulations. All patients had negative sputum cultures at the end of the treatment, and no relapse occurred after one year of follow-up. CONCLUSIONS: In this randomized study, transient higher serum bilirubin levels were noted for the fixed-dose combination regimen compared with the separate formulations during treatment. However, no significant difference in safety or efficacy was found between the groups when the directly observed treatment short-course strategy was used. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Antitubercular Agents/administration & dosage , Tuberculosis, Pulmonary/drug therapy , Antitubercular Agents/adverse effects , Bilirubin/blood , Drug Administration Schedule , Drug Combinations , Directly Observed Therapy/methods , Drug Therapy, Combination/adverse effects , Drug Therapy, Combination/methods , Follow-Up Studies , Hyperuricemia/chemically induced , Prospective Studies , Skin Diseases/chemically induced , Sputum/microbiology , Treatment Outcome , Tuberculosis, Pulmonary , Vision Disorders/chemically induced
4.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-159744

ABSTRACT

Introduction: Tuberculosis (TB) is a major public health problem worldwide. Two deaths occur for every three minutes in India due to tuberculosis and two people become sputum positive for tuberculosis every minute. Designated Microscopic Centre (DMC) is the most peripheral laboratory unit under RNTCP catering to population of one lakh. Objective: To know the outcome of tuberculosis patients in terms of treatment success, cured, treatment completed, transferred out, died and defaulted among registered TB cases under DMC. Methodology: Five years’ secondary data about tuberculosis patients on DOTS under the Designated Microscopic Centre (DMC), Vantamuri (R) PHC, Belgaum from January 2008 to March 2013 was included. Total of 182 patients on DOTS, who were enrolled under Vantamuri (R) DMC during this period were included for data analysis. Revised International Union Against Tuberculosis and Lung Diseases (IUATLD, 2001) definitions in tuberculosis control were used. Data was analysed using percentages. Results: Among 182 study participants, 105 patients (57.7%) were males and 77 (42.3%) were females. Overall treatment success rate was 90.7% among TB patients enrolled under Vantamuri (R) DMC. Conclusion: Males were affected more than females by TB. Eight out of ten TB patients were in the age group of 20-60 years. Study area DMC performed similar to national averages.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Directly Observed Therapy/methods , Female , Humans , India , Infant , Infant, Newborn , Male , Middle Aged , Primary Health Care/organization & administration , Retrospective Studies , Treatment Outcome , Tuberculosis/drug therapy , Tuberculosis/mortality , Young Adult
6.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-140270

ABSTRACT

Background & objectives: New diagnostic tests for tuberculosis, especially those based on nucleic acid amplification, offer the possibility of early and accurate diagnosis of active TB. In this study we use mathematical modelling to explore the potential epidemiological impact of these new tests, with particular reference to India. Methods: A behavioural model of patient-doctor interactions embedded in an epidemiological model of Mycobacterium tuberculosis transmission, linked to field data, was used to investigate the effects of early diagnosis in preventing future TB cases. Results: New diagnostic tests for active TB will have a bigger impact sooner where: disease incidence is high and most cases are due to recent infection; advances in test technology (test sensitivity, specificity, etc.) are combined with early diagnosis; new tests have not only better technical specifications than current tests, but also compensate for the misuse of existing tests; health system delays are long compared with patient delays, assuming the former are more amenable to change. Interpretation & conclusions: New diagnostic tests will certainly improve TB control, but the highest impact will be obtained by applying tests with higher sensitivity and specificity early in the infectious period. Refined behavioural and epidemiological models should be able to investigate the mechanisms by which early diagnosis could be achieved, in addition to the consequent epidemiological effects.


Subject(s)
Diagnosis , Diagnostic Tests, Routine/methods , Health Systems Plans/statistics & numerical data , Humans , Mycobacterium tuberculosis , Tuberculosis/diagnosis , Tuberculosis/transmission , Time Factors , Behavior , Directly Observed Therapy/methods , Humans , Government Programs/statistics & numerical data , Humans , India , National Health Programs/trends , National Health Programs/statistics & numerical data , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy
7.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-140266

ABSTRACT

The Phase II (2006-2012) of the Revised National Tuberculosis Control Programme (RNTCP) has been successful in achieving its objectives. Tuberculosis (TB) disease burden (prevalence and mortality) in India has reduced significantly when compared to 1990 levels, and India is on track to achieve the TB related millennium development goals. Despite significant progress, TB still continues to be one of the major public health problems in the country, and intensified efforts are required to reduce TB transmission and accelerate reductions in TB incidence, particularly in urban areas and difficult terrains. Achieving ‘Universal access’ is possible and necessary for the country. RNTCP during the 12th Five Year Plan (2012-2017) aims to achieve ‘Universal access’ to quality assured TB diagnosis and treatment and elaborate plans are being made. This requires broad and concerted efforts and support from all stakeholders with substantial enhancement of commitment and financing at all levels. This paper describes the new vision of RNTCP and an overview of how this will be achieved.


Subject(s)
Directly Observed Therapy/methods , Government Programs/trends , Government Programs/statistics & numerical data , National Health Programs/trends , National Health Programs/statistics & numerical data , India , Tuberculosis/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy
8.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-140265

ABSTRACT

The scale up of DOTS in India is one of the greatest public health accomplishments, and yet undiagnosed and poorly managed TB continues to fuel the epidemic such that India continues to have the highest number of TB cases in the world. Recognizing these challenges, the Government of India has set an ambitious goal of providing universal access to quality diagnosis and treatment for all TB patients in the country. Innovative tools and delivery systems in both the public and private sectors are essential for reaching this goal. Fortunately, India has the potential to solve its TB problem with “home-grown” solutions. Just as Indian pharmaceutical companies revolutionized access to high-quality, affordable AIDS drugs through generic production, Indian diagnostic companies could also become the world's hub for high-quality generic diagnostics. In the long term, India has the potential to lead the world in developing innovative TB diagnostics. For this to happen, Indian industry must move from the import and imitation approach to genuine innovation in both product development as well as delivery. This must be supported by permissive policies and enhanced funding by the Indian government and the private sector. Strict regulation of diagnostics, increased attention to quality assurance in laboratories, and greater engagement of the private health care providers are also needed to effectively deliver innovative products and approaches.


Subject(s)
Directly Observed Therapy/methods , Humans , India , Tuberculosis/diagnosis
9.
J. bras. pneumol ; 37(2): 223-231, mar.-abr. 2011. ilus, tab
Article in Portuguese | LILACS (Americas) | ID: lil-583923

ABSTRACT

OBJETIVO: Verificar a adesão ao tratamento dos casos atendidos no programa de controle da tuberculose do município de Carapicuíba (SP), antes e após a implantação da estratégia directly observed treatment, short-course (DOTS, tratamento supervisionado). MÉTODOS: Estudo operacional do tipo coorte histórica a partir dos registros de comparecimento e evolução do tratamento dos pacientes submetidos ao tratamento autoadministrado (TAA) e daqueles submetidos a DOTS. Tábuas de desfecho de tratamento mês a mês foram elaboradas, e a probabilidade de adesão foi calculada para cada grupo de pacientes. RESULTADOS: Um total de 360 pacientes com tuberculose preencheu os critérios de elegibilidade: 173 (48,1 por cento) no grupo TAA e 187 (51,9 por cento) no grupo TS. A adesão ao tratamento foi 6,1 por cento maior no grupo DOTS do que no grupo TAA. Ao final de seis meses, 91,6 por cento dos pacientes sob TS completaram o tratamento padrão, enquanto 85,5 por cento dos pacientes do grupo TAA completaram o tratamento. CONCLUSÕES: Este estudo mostrou que a estratégia DOTS pode ser realizada com sucesso em unidades básicas de saúde e que essa estratégia foi mais efetiva que o TAA nesta população de pacientes de uma cidade com população de baixa renda e alta carga de tuberculose.


OBJECTIVE: To determine the compliance with tuberculosis treatment among patients enrolled the tuberculosis control program in the city of Carapicuíba, Brazil, before and after the implementation of the directly observed treatment, short-course (DOTS) strategy. METHODS: A retrospective historical cohort study of operational aspects based on records of attendance and treatment evolution of patients in self-administered treatment (SAT) and of those submitted to DOTS. Monthly treatment outcome tables were created, and the probability of compliance with the treatment was calculated for both groups of patients. RESULTS: A total of 360 patients with tuberculosis met the inclusion criteria: 173 (48.1 percent) in the SAT group; and 187 (51.9 percent) in the DOTS group. Treatment compliance was 6.1 percent higher in the DOTS group than in the SAT group. The proportion of patients completing the six months of treatment was 91.6 percent and 85.5 percent in the DOTS group and in the SAT group, respectively. CONCLUSIONS: The results of this study show that DOTS can be successfully implemented at primary health care clinics. In this population of patients, residents of a city with low incomes and a high burden of tuberculosis infection, DOTS was more effective than was SAT.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Directly Observed Therapy/standards , Medication Adherence/statistics & numerical data , Tuberculosis/drug therapy , Brazil , Cohort Studies , Directly Observed Therapy/methods , Program Evaluation , Retrospective Studies , Socioeconomic Factors , Self Administration/statistics & numerical data
10.
J. bras. pneumol ; 35(10): 998-1007, out. 2009. ilus, tab, mapas
Article in English, Portuguese | LILACS (Americas) | ID: lil-530495

ABSTRACT

OBJETIVO: Caracterizar o perfil dos pacientes com tuberculose pulmonar (TBP) no município de Santos (SP) segundo fatores biológicos, ambientais e institucionais. MÉTODOS: Estudo descritivo, com dados obtidos na vigilância da TB, abrangendo pacientes com TBP maiores de 15 anos de idade, residentes em Santos (SP) e com tratamento iniciado entre 2000 e 2004. RESULTADOS: Foram identificados 2.176 casos, e 481 apresentavam história prévia de TB. Desses, 29,3 por cento curaram-se no episódio anterior, e 70,7 por cento abandonaram o tratamento. Em 61,6 por cento e em 33,8 por cento dos casos, o diagnóstico foi confirmado por baciloscopia e por critérios clínico-radiológicos, respectivamente; 69.0 por cento eram homens, e 69,5 por cento situavam-se entre 20 a 49 anos. Houve 732 hospitalizações, com tempo médio de permanência de 32 dias na primeira internação. A prevalência de alcoolismo, diabetes e coinfecção TB/HIV foi de, respectivamente, 11,7 por cento, 8,2 por cento e 16,2 por cento, com declínio dessa última de 20,7 por cento para 12,9 por cento no período de estudo. O desfecho do tratamento para 71,0 por cento, 12,1 por cento, 3,2 por cento e 3,3 por cento foi, respectivamente, cura, abandono, óbito por TB e óbito por TB/HIV. O tratamento supervisionado de curta duração foi aplicado em 63,4 por cento dos casos, e não houve diferenças nos desfechos entre os tipos de tratamento (p > 0,05). A incidência anual média de TBP foi de 127,9/100.000habitantes (variação: 72,8-272,92/100.000 conforme a região). A taxa anual média de mortalidade por TBP foi de 6,9/100.000 habitantes. CONCLUSÕES: Em áreas hiperendêmicas de TB, o tratamento supervisionado de curta duração deve ser priorizado para os grupos de risco para o abandono de tratamento ou óbito, e a busca de TB entre contatos deve ser intensificada.


OBJECTIVE: To characterize the profile of patients with pulmonary tuberculosis (PTB) in the city of Santos, Brazil, according to biological, environmental and institutional factors. METHODS: Descriptive study, using the TB surveillance database, including patients with PTB, aged 15 years or older, residing in the city of Santos and whose treatment was initiated between 2000 and 2004. RESULTS: We identified 2,176 cases, of which 481 presented a history of TB. Of those 481 patients, 29.3 percent were cured, and 70.7 percent abandoned treatment. In 61.6 percent of the cases, the diagnosis was confirmed by sputum smear microscopy, whereas it was confirmed based on clinical and radiological criteria in 33.8 percent; 69.0 percent were male; and 69.5 percent were between 20 and 49 years of age. There were 732 hospitalizations, and the mean length of hospital stay was 32 days (first hospitalization). The prevalence of alcoholism, diabetes and TB/HIV coinfection was, respectively, 11.7 percent, 8.2 percent and 16.2 percent. The prevalence of TB/HIV coinfection decreased from 20.7 percent to 12.9 percent during the study period. The treatment outcome was cure, abandonment, death from TB and death attributed to TB/HIV coinfection in 71.0 percent, 12.1 percent, 3.9 percent and 2.5 percent, respectively. The directly observed treatment, short-course (DOTS) was adopted in 63.4 percent of cases, and there were no significant differences between DOTS and the conventional treatment approach in terms of outcomes (p > 0.05). The mean annual incidence of PTB was 127.9/100,000 population (range: 72.8-272.92/100,000 population, varying by region). The mean annual mortality rate for PTB was 6.9/100,000 population. CONCLUSIONS: In areas hyperendemic for TB, DOTS should be prioritized for groups at greater risk of treatment abandonment or death, and the investigation of TB contacts should be intensified.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Endemic Diseases/statistics & numerical data , Tuberculosis, Pulmonary/epidemiology , Brazil/epidemiology , Directly Observed Therapy/methods , Directly Observed Therapy/statistics & numerical data , Epidemiologic Methods , Hospitalization/statistics & numerical data , Retreatment/statistics & numerical data , Socioeconomic Factors , Treatment Outcome , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/therapy , Young Adult
11.
Indian J Pediatr ; 2009 Jul; 76(7): 739-742
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-142328

ABSTRACT

There has been significant change in management of tuberculosis ever since pre-chemotherapeutic era to the present day RNTCP protocol based on specific disease catrogies. This has been based on knowledge of rational use of anti-TB drugs. DOTS has added new dimensions to TB control program. Public-private partership will foster the way ahead for better outcome, only if every physician follows management protocol.


Subject(s)
Adolescent , Antitubercular Agents/therapeutic use , Child , Child, Preschool , Communicable Disease Control/trends , Directly Observed Therapy/methods , Disease Management , Female , Forecasting , Humans , India , National Health Programs , Prevalence , Tuberculosis/diagnosis , Tuberculosis/drug therapy , Tuberculosis/epidemiology
12.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-113054

ABSTRACT

We report here that the Directly Observed Treatment, Short course (DOTS) is reaching all tuberculosis patients in the community irrespective of social classification based on the analysis from the tuberculosis prevalence survey and programme performance during 1999-2003 from a rural area in Tamilnadu, South India. New smear- positive cases treated under a DOTS programme were classified in two groups namely; scheduled caste living in colony and other population. The prevalence of smear- positive cases among the scheduled caste population was 1.9 times higher than the other population and this was reflected in the notification also. The successful treatment outcome was also similar in these two groups (75% and 78% respectively; overall 77%). From these findings it is concluded that people living in colony have equal access to DOTS as those in the village.


Subject(s)
Adolescent , Adult , Chi-Square Distribution , Directly Observed Therapy/methods , Female , Humans , India , Male , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Rural Health , Social Class , Socioeconomic Factors , Sputum/microbiology , Tuberculosis/epidemiology
13.
J. bras. pneumol ; 34(7): 506-513, jul. 2008. tab
Article in English, Portuguese | LILACS (Americas) | ID: lil-488277

ABSTRACT

OBJETIVO: Avaliar a utilização de supervisores domiciliares para dose supervisionada do tratamento(DOT), em pacientes portadores de tuberculose. MÉTODOS: Trata-se de um estudo descritivo prospectivo com amostra composta por pacientes com diagnóstico de tuberculose pulmonar. Participaram deste estudo 98 pacientes. Um protocolo de capacitação do paciente e sua família foi implementado. Após este treinamento, o paciente poderia escolher entre um supervisor domiciliar e um profissional de saúde. Os métodos de análise descritiva utilizados foram a freqüência absoluta e relativa. RESULTADOS: Um supervisor familiar foi escolhido por 94 pacientes (96 por cento). O percentual de cura foi de 99 por cento. O parceiro foi escolhido por 49 por cento e algum outro familiar o foi por 28 por cento dos pacientes. A equipe de pesquisa precisou assumir o DOT em 3 por cento dos casos. O comparecimento regular para a supervisão foi de 67 por cento. Verificou-se que 24 por cento dos problemas encontrados neste modelo de DOT referiram-se ao esquecimento em administrar ou tomar as medicações, por parte do supervisor e do paciente, respectivamente, sendo que 39 por cento dos pacientes deixaram de tomar a medicação por um dia e 31 por cento esqueceram-se de tomá-la por dois dias durante o tratamento. Houve troca de supervisor em 9 por cento da amostra, perda de medicação pelo paciente em algum momento do tratamento em 9 por cento e intolerância do paciente à medicação em 8 por cento. CONCLUSÕES: O DOT supervisionado pelo familiar mostrou-se eficaz e de baixo custo. No entanto, a adesão ao tratamento não de deve a um só fator, mas ao conjunto de medidas adotadas: vale transporte; ações educativas; e, principalmente, a abordagem individualizada.


OBJECTIVE: To evaluate the use of family members as supervisors of directly observed therapy (DOT) in patients with tuberculosis. METHODS: This was a prospective descriptive study involving patients diagnosed with pulmonary tuberculosis. The sample comprised 98 patients. A standardized protocol was implemented in order to train the patient and their families. After the training, the patient was allowed to choose either a family member or a health care worker as a supervisor. Absolute and relative frequencies were used in descriptive data analysis. RESULTS: A family member supervisor was chosen by 94 patients (96 percent). The cure rate was 99 percent. The partner was chosen by 49 percent of the patients, and other family members were chosen by 28 percent. The heath care team needed to take over DOT in 3 percent of the cases. Regular attendance at follow-up appointments was 67 percent. It was observed that 24 percent of the problems in this DOT model referred to the family supervisor forgetting to administer the medication or to the patient forgetting to take it; 39 percent of the patients forgot to take the medication for one day, and 31 percent forgot to take it for two days. There was change of supervisor in 9 percent of the sample, medication was lost by the patient sometime during treatment in 9 percent, and patient drug intolerance occurred in 8 percent. CONCLUSIONS: DOT supervised by a family member has proven an effective and low-cost technique. However, compliance is not due to one single factor but to the combination of strategies adopted: bus passes; educational measures and especially the individualized approach.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Caregivers , Directly Observed Therapy/methods , Home Care Services , Patient Compliance , Tuberculosis, Pulmonary/therapy , Brazil , Caregivers/psychology , Family , Follow-Up Studies , Patient Care Team , Prospective Studies , Patient Compliance/psychology , Socioeconomic Factors , Young Adult
16.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-36298

ABSTRACT

The study objectives were to compare the proportions of tuberculosis (TB) cases detected under a project launched in lower part of southern Thailand 1) by screener type [village health volunteer (VHV), health center staff, and hospital staff]; and 2) by region. Among 688 people with suspected TB symptoms referred to have sputum examination with or without chest radiograph, 55 (8%) were diagnosed of TB, including 44 (6%) smear-positive cases. The proportions of smear-positive cases among those screened by VHV, health center and hospital staff were 6.7%, 3.4% and 12.9%; respectively. The corresponding proportions for TB cases were 8.4%, 5.1%, and 12.9%. The proportions of smear-positive cases were 2.5%, 21.7%, and 14.6% for those from the Region A, B and C, respectively. The corresponding proportions of TB cases were 3.5%, 26.5%, and 16.7%. The differences by screener type were not statistically significant. VHV performances in TB case detection were comparable to health center and hospital staff, even under conditions of unrest in one province in Region B and three provinces in Region C.


Subject(s)
Adult , Aged , Community Health Workers , Community Health Centers , Directly Observed Therapy/methods , Female , Humans , Male , Mass Screening/methods , Middle Aged , Mycobacterium/isolation & purification , Personnel, Hospital , Sputum/microbiology , Thailand , Tuberculosis, Pulmonary/microbiology , Violence , Volunteers
17.
J. bras. pneumol ; 33(3): 287-294, maio-jun. 2007. graf, tab
Article in Portuguese | LILACS (Americas) | ID: lil-461992

ABSTRACT

OBJETIVO: Analisar o Programa de Controle da Tuberculose em Cáceres, Mato Grosso, entre 1999 e 2004, e o impacto que sobre ele teve a implantação do Programa de Saúde da Família, ocorrida em 2000. MÉTODOS: Estudo epidemiológico descritivo, com base nos registros de casos de tuberculose diagnosticados e tratados em Cáceres, segundo as características dos doentes, o cumprimento ou não do protocolo para o diagnóstico, tratamento e acompanhamento dos doentes e o tipo de unidade de saúde responsável pelo atendimento. RESULTADOS: A incidência de tuberculose foi reduzida de 99,4 para 49,8 (por 100 mil habitantes) de 1999 a 2004. Os doentes apresentaram características similares às dos doentes de outras regiões do Brasil, com maioria do sexo masculino em idade economicamente produtiva. Entre os portadores de formas pulmonares atendidos pelo Programa de Saúde da Família, o número de baciloscopias realizadas no momento do diagnóstico (OR = 0,33; IC95 por cento: 0,16-0,66) e no momento da alta (OR = 0,32; IC95 por cento: 0,18-0,59) foi menor. Os pacientes acompanhados pelo Programa de Saúde da Família apresentaram uma taxa de cura 16,4 por cento menor do que os pacientes atendidos na unidade de referência, assim como tiveram maior probabilidade de abandonarem o tratamento (OR = 2,93; IC95 por cento: 1,15-7,46) e maior probabilidade de irem a óbito (OR = 5,71; IC95 por cento: 1,85-18,1). CONCLUSÃO: A desconcentração do atendimento para unidades de saúde da família não resultou em melhoria no atendimento e acompanhamento dos casos de tuberculose do município de Cáceres.


OBJECTIVE: To analyze the effectiveness of the Tuberculosis Control Program, in conjunction with the recently incorporated Family Health Program, in the city of Cáceres, Brazil, between 1999 and 2004. METHODS: This was a descriptive epidemiological study, based on the registry of tuberculosis cases diagnosed and treated in Cáceres, according to the characteristics of the cases diagnosed, whether or not the protocol for diagnosis, treatment, and monitoring of patients was followed, as well as the type of health care facility involved. RESULTS: The incidence of tuberculosis was reduced from 99.4 to 49.8 (per 100,000 inhabitants) between 1999 and 2004. The patients presented characteristics similar to those of patients from other regions of Brazil, with a predominance of males during their most economically productive years. Among the patients presenting pulmonary forms and treated via the Family Health Program, there was a reduction in the number of sputum smear microscopies performed at the moment of diagnosis (OR = 0.33; 95 percentCI: 0.16-0.66) and prior to discharge (OR = 0.32; 95 percentCI: 0.180.59). The patients monitored via the Family Health Program presented a 16.4 percent lower cure rate than did those treated at the referral center, as well as being more likely to abandon treatment (OR = 2.93; 95 percentCI: 1.15-7.46) and to die (OR = 5.71; 95 percentCI: 1.8518.1). CONCLUSION: The decentralization of the treatment services to the family health clinics did not improve the treatment or monitoring of tuberculosis cases in the city of Cáceres.


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Family Health , National Health Programs , Tuberculosis/epidemiology , Age Distribution , Brazil/epidemiology , Directly Observed Therapy/methods , Epidemiologic Methods , Program Evaluation , Patient Dropouts/statistics & numerical data , Sex Distribution , Time Factors , Treatment Outcome , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiology , Tuberculosis/diagnosis , Tuberculosis/drug therapy
18.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-110498

ABSTRACT

BACKGROUND: Revised National TB Control Programme has been implemented since 1998 in Bangalore metropolitan city which has several big general hospitals, including two TB sanatoria which attract a large number of respiratory symptomatic and TB patients. Till recently there was significant loss of patients for follow up because of lack of mechanism to reach the patients, good recording practices and linkage with district TB control office. OBJECTIVE: To establish an effective referral mechanism between TB sanatoria and peripheral health institutions of the government for providing un-interrupted supervised treatment (DOT) to all newly detected TB patients. METHOD: TB sanatoria remain as "islands" when Reyised National TB Control Programme (RNTCP) with DOTS strategy is implemented. Damien Foundation India Trust (DFIT) provided a Technical Support Team (one medical consultant and three supervisors) to assist in implementation of RNTCP in the district. DFIT liaised with both partners and established procedures for recording correct address, informing health institutions and Senior TB Supervisors (STS) and monitoring referrals. Referral slip and a copy of treatment card were given to patients. One copy of treatment card was sent to respective health facility. Initially the number of STS was not adequate to follow up the patients. The supervisors of Technical Support Team ensured that they were treated in peripheral health institutions or near patients' residence. All STS were in position one year after initiation of this effort. RESULTS: The referral system is functional. Case holding improved from about 50% to 85% during 2002-2005 by effective transfer through referrals. CONCLUSION: Interfacing of NGO between district TB control office and TB sanatoria enabled the establishment of effective collaboration. Initial reluctance was replaced by complete participation in the TB control programme.


Subject(s)
Community Health Services/organization & administration , Directly Observed Therapy/methods , Female , Humans , India , Male , Program Evaluation , Retrospective Studies , Treatment Outcome , Tuberculosis/rehabilitation , Urban Population
19.
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-19345

ABSTRACT

Multidrug-resistant tuberculosis (MDR-TB) caused by Mycobacterium tuberculosis resistant to both isoniazid and rifampicin with or without resistance to other drugs is among the most worrisome elements of the pandemic of antibiotic resistance. Globally, about three per cent of all newly diagnosed patients have MDR-TB. The proportion is higher in patients who have previously received antituberculosis treatment reflecting the failure of programmes designed to ensure complete cure of patients with tuberculosis. While host genetic factors may probably contribute, incomplete and inadequate treatment is the most important factor leading to the development of MDR-TB. The definitive diagnosis of MDR-TB is difficult in resource poor low income countries because of non-availability of reliable laboratory facilities. Efficiently run tuberculosis control programmes based on directly observed treatment, short-course (DOTS) policy is essential for preventing the emergence of MDR-TB. Management of MDR-TB is a challenge which should be undertaken by experienced clinicians at centres equipped with reliable laboratory service for mycobacterial culture and in vitro sensitivity testing as it requires prolonged use of expensive second-line drugs with a significant potential for toxicity. Judicious use of drugs, supervised individualised treatment, focussed clinical, radiological and bacteriological follow up, use of surgery at the appropriate juncture are key factors in the successful management of these patients. In certain areas, currently available programme approach may not be adequate and innovative approaches such as DOTS-plus may have to be employed to effectively control MDR-TB.


Subject(s)
Causality , Directly Observed Therapy/methods , Disease Management , Drug Resistance/genetics , Humans , Immunotherapy/methods , India/epidemiology , Mycobacterium tuberculosis/genetics , Tuberculosis, Multidrug-Resistant/diagnosis
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