RESUMO
Tuberculosis (TB) has a higher incidence in populations with socio-economic deficits and requires prolonged antibiotic therapy to heal, which hinders adherence to the treatment, with an abandonment rate ranging between 15 and 30% in those with self-administered treatment. Objectives: to assess the rate of abandonment and to identify predisposing factors in patients monitored at the hospital with self-administered treatment, implemented with weekly controls during the attack phase, and then monthly controls (consolidation phase) until completing the planned schedule. Materials and methods: all the patients who started treatment between January 1st and December 31st, 2015 were included. A descriptive analysis of the results obtained up to December 31st, 2016 was performed. An interruption ≥ 14 days during the attack phase and ≥ 2 months during the consolidation phase was defined as abandonment by comparing the characteristics of this group with the compliant group using the chi-square test. Results: 73 patients (38 males) aged 34±15 years were included, 32 were Argentine (44%), and the rest was comprised of: 33 Bolivians, 5 Paraguayans, 2 Peruvians and 1 Chilean. In 47 cases (64%), TB was pulmonary. The extrapulmonary damage included: 11 pleural, 5 nodal, 3 bone (one with a concomitant impact on the psoas and another one on the lung), 2 laryngeal and pulmonary, 2 peritoneal, 2 meningeal and 1 intestinal. In all the cases (except for one that started treatment empirically), the disease was confirmed by direct AFB smear or culture, or by finding granulomas in biopsies performed in a compatible clinical context. Fifty-two patients completed the treatment (71.2%), 1 patient passed away and 20 abandoned it (27.4%); of the latter, 4 restarted and completed the treatment. The most frequent comorbidities were alcoholism (n = 7), diabetes (n = 6), and HIV positives (n = 6). Compared to the group that completed the treatment, alcoholism was a significant predictive factor for abandonment (2 in 52 vs. 5 in 20; p < .01). There were no significant differences regarding HIV positives (4 in 52 vs. 2 in 20) or gender (9 out of 38 males abandoned treatment vs. 11 out of 34 females). Likewise, there were no differences regarding age, nationality or education level. Conclusion: with the self-administered treatment system, we obtained an abandonment rate no higher than the expected one at our hospital. Alcoholism was associated with a higher risk of abandonment. Identifying other predisposing factors will help to improve adherence to the treatment by defining specific follow-up strategies.
Assuntos
Terapêutica , TuberculoseRESUMO
Introdução: o objetivo deste estudo foi descrever a implementação da estratégia DOTS (Estratégia de Tratamento Diretamente Observado de Curta duração) nos centros de saúde na cidade do Rio de Janeiro, apresentando os resultados obtidos após dois anos de desenvolvimento de projetos-piloto. Métodos: análise dos dados contidos nos "Livros de Registro e Controle do Tratamento", regularmente notificados à Secretaria Municipal de Saúde do Rio de Janeiro, visando avaliar o impacto do tratamento diretamente observado (DOT) nos índices de cura e o efeito da implementação da estratégia DOTS na qualidade do programa de controle da tuberculose (PCT). Resultados: De Janeiro de 1999 a Dezembro de 2001, 3657 casos de TB foram registrados nas áreas onde a estratégia DOTS foi implantada. Destes, 1730 receberam DOT e 1927 receberam tratamento auto-administrado (TAA). Entre os caos novos, 81% dos que receberam DOT e 71% dos que receberam TAA foram tratados com sucesso (OR 1,66, IC 95%: 1,3 -1,8), p<0,01. As taxas de negativação da baciloscopia do escarro após 2 e 3 meses de tratamento foram de 84% e 91% respectivamente para aqueles que receberam DOT e 75% e 83% para o grupo em TAA. Nos centros de saúde onde a estratégia DOTS foi implantada houve, em 3 anos, melhora geral dos índices de cura e de abandono, assim como dos percentuais de baciloscopias realizadas para acompanhamento do tratamento. Conclusão: Pacientes que receberam DOTS tiveram maior chance de cura do que aqueles que receberam TAA. A implantação da estratégia DOTS melhorou a qualidade do PCT.
Introduction: The objective of this study is to describe the implementation of DOTS (Directly Observed Treatment, Short course) strategy in health centers in the city of the Rio de Janeiro presenting the results 2 years after teh development of pilot projects. Methods: analysis of data recorded on the "TB treatment and outcome registration books", regularly reported to the City Health Secretariat, to evaluate the results of the directly observed therapy (DOT) on the treatment success rates and the effect of DOTS implementation on the equality of the TB control program. Results: From January 1999 to December 2001, 3,657 TB cases were registered in the areas where the DOTS strategy was implemented. Of these, 1,730 received directly observed treatment (DOT) and 1,927 received self-administered treatment (SAT). In the DOT group 81% of the new cases were treated successfully, whereas in the SAT 71% of the new cases were treated successfully (OR1,66, 95% CI:1,3 -1,8, p <0,01). The sputum smear conversion rates for the new cases after 2 and 3 months' treatment were respectively 84% and 91% for the group on DOT and 75% and 83% for those on SAT. In the health centers where the DOTS strategy was implemented there was a general improvement on the cure and default rates, and also on the proportion of patients monitored bacteriologically during treatment. Conclusion: patients receiving DOT were much more likely to complete treatment than those receiving SAT. The implementation of the DOTS strategy improved the quality of the TB control program.