Boletim Epidemiológico: perfil epidemiológico dos casos novos de tuberculose drogarresistente notificados no Estado de Goiás 2015-2021 / Epidemiological Bulletin: epidemiological profile of new cases of drug-resistant tuberculosis reported in the State of Goiás 2015-2021

De acordo com a Organização Mundial da Saúde (OMS) a epidemia da tuberculose (TB) no mundo é classificada em três grandes listas: países de alta carga de tuberculose, países de alta carga para coinfecção TB relacionada a Síndrome da Imunodeficiência Adquirida (HIV) e países com alta carga de tuberculose drogarressitente. O Brasil se faz presente na lista de países de alta carga de tuberculose e de coinfecção TB/HIV, o que é um desafio para a detecção e acompanhamento desses casos, com uma grande representatividade epidemiológica no cenário mundial1 Sendo assim, o objetivo deste boletim é descrever o perfil epidemiológico dos pacientes considerados como casos novos de tuberculose drograrresistente notificados no estado de Goiás entre os anos de 2015 ­ 2021 e subsidiar a rede para tomada de decisões em saúde pública

According to the World Health Organization (WHO), the tuberculosis (TB) epidemic in the world is classified into three major lists: countries with a high burden of tuberculosis, countries with a high burden of TB co-infection related to Acquired Immunodeficiency Syndrome (HIV) and countries with a high burden of drug-resistant tuberculosis. Brazil is present on the list of countries with a high burden of tuberculosis and TB/HIV co-infection, which is a challenge for the detection and follow-up of these cases, with a great epidemiological representativeness on the world stage1 Therefore, the objective of this bulletin is to describe the epidemiological profile of patients considered as new cases of drug-resistant tuberculosis notified in the state of Goiás between the years 2015 ­ 2021 and subsidize the network for decision-making in public health

Analysis of tuberculosis epidemiological characteristics and drug resistance among the floating population in Beijing in 2019 / 中华流行病学杂志

Objective: To analyze the epidemic characteristics and drug resistance of pulmonary tuberculosis among the floating population in Beijing and to provide a scientific basis for formulating strategies for the prevention and control of tuberculosis among the floating population. Methods: Data of tuberculosis patients who were positive for Mycobacterium tuberculosis culture was collected from 16 districts and one municipal institution of tuberculosis control and prevention in Beijing in 2019. The strain samples were tested for drug sensitivity by the proportional method. According to household registration location, patients were divided into the floating population and Beijing registration. SPSS 19.0 software analyzed tuberculosis patients' epidemic characteristics and drug resistance in the floating population. Results: In 2019, there were 1 171 culture-positive tuberculosis patients in Beijing, among the floating population, 593 (50.64%) patients were identified, with a male-to-female sex ratio of 2.2∶1 (409∶184). Compared to patients under household registration as Beijing residents, a higher proportion of young adults aged 20-39 years (65.09%,386/593) were noticed, with 55.65% (330/593) reported from the urban areas and 96.80% (574/593) were reported the first time. The differences were statistically significant (all P<0.05). After completing the drug sensitivity test, 37 cases were with multiple drug-resistant tuberculosis, accounting for 6.24% (37/593). The rates of isoniazid resistance (42.11%,8/19) and multidrug resistance (21.05%,4/19) in floating population patients after retreatment were significantly higher than those in newly treated patients (11.67%, 67/574 and 5.75%, 33/574), and the differences were statistically significant (all P<0.05). Conclusions: Most patients with tuberculosis in the floating population in Beijing in 2019 were young males aged 20-39 years. The reporting areas were urban areas and the newly treated patients mainly. The patients with tuberculosis in the re-treated floating population were more likely to suffer from multidrug and drug resistance, which should be taken as the key population for prevention and control.

Barriers faced by patients in the diagnosis of multidrug-resistant tuberculosis in Brazil

ABSTRACT OBJECTIVE To understand patients' narratives about the barriers they faced in the diagnosis and treatment of multidrug-resistant tuberculosis, and their consequences in Rio de Janeiro State, Brazil. METHODS This is a qualitative cross-sectional study with non-probabilistic sampling. A theoretical saturation criterion was considered for composing the number of interviewees. Semi-structured interviews were conducted from August to December 2019 with 31 patients undergoing treatment for multidrug-resistant tuberculosis at an outpatient referral center in Rio de Janeiro. Data were transcribed and processed with the aid of the NVIVO software. Interviews were evaluated by content analysis, and their themes, cross-referenced with participants' characterization data. RESULTS Our main findings were: a) participants show a high proportion of primary drug resistance, b) patients experience delays in the diagnosis and effective treatment of multidrug-resistant tuberculosis ; c) healthcare providers fail to value or seek the diagnosis of drug-resistant tuberculosis, thus beginning the inadequate treatment for drug-susceptible tuberculosis, d) primary health units show low report rates of active case-finding and contact monitoring, and e) patients show poor knowledge about the disease. CONCLUSIONS We need to improve referral systems, and access to the diagnosis and effective treatment of multidrug-resistant tuberculosis; conduct an active investigation of contacts; intensify the training of healthcare providers, in collaboration with medical and nursing schools, in both public and private systems; and promote campaigns to educate the population on tuberculosis signs and symptoms.

Tuberculosis farmacorresistente en provincia Guantánamo, 2010-2019 / Drug-resistant tuberculosis in Guantánamo province, 2010-2019 / Tuberculose resistente a medicamentos na província de Guantánamo, 2010-2019

RESUMEN Introducción: En los últimos 10 años en Cuba y, especialmente, en provincia Guantánamo se ha observado incremento del número de pacientes tuberculosos farmacorresistentes; esta es la provincia de mayor incidencia en el país. Objetivo: Identificar las características epidemiológicas y el patrón de resistencia de la tuberculosis farmacorresistente en provincia Guantánamo. Método: Se diseñó un estudio descriptivo y transversal que incluyó la totalidad de casos (n=6) con tuberculosis farmacorresistentes diagnosticados entre diciembre de 2010 y diciembre de 2019. Se estudiaron las variables: edad, sexo, régimen terapéutico, situación económica, categorías de casos, clasificación epidemiológica de la resistencia y resistencia de la cepa aislada según el grado y perfil. Resultados: Predominó el sexo masculino (66, 6 %) y el grupo de edades de menores de 45 años (83,3 %), la mayor cantidad de resistencia estuvo propiciada por violaciones en los tratamientos anteriores (66,6 %), categorizados mayormente como crónicos y reingresos por abandono. Predominó el nivel educacional de secundaria básica terminada (66,7 %), con situación económica regular (50,0 %) y alto nivel de alcoholismo (66,7 %). La multidrogorresistencia prevaleció en cepas de pacientes con tratamiento previo (66,6 %). Conclusiones: Existe coincidencia del patrón epidemiológico y el patrón de resistencia mostrado en la investigación actual con los resultados de estudios previos nacionales e internacionales, estos resultados sugieren fallas en la aplicación local del Programa Nacional de Control y Tratamiento de la tuberculosis. Se recomienda investigar y resolver estas fallas lo que produciría un impacto inmediato en la disminución de la incidencia de tuberculosis farmacorresistentes.

ABSTRACT Introduction: An increase in the number of drug-resistant tuberculosis patients has been observed in the last 10 years in Cuba and, especially, in Guantánamo province. This is the province with the highest incidence in the country. Objective: To identify the epidemiological characteristics and the resistance pattern of drug-resistant tuberculosis in Guantánamo province. Method: A descriptive, cross-sectional study was designed that included all cases (n=6) with drug-resistant tuberculosis, diagnosed between December 2010 and December 2019. The variables studied were: age, gender, therapeutic regimen, economic situation, categories of cases, epidemiological classification of resistance, and resistance of the isolated strain according to the grade and profile. Results: Males predominated (66.6%), and also the age group under 45 years (83.3%), the greatest resistance was caused by not abiding the previous treatments (66.6%), categorized mostly as chronic, and readmitted due to treatment abandonment. Highschool degree (66.7%) predominated, with a moderate economic situation (50.0%) and high levels of alcoholism (66.7%). Multi-drug resistance prevailed in the strains in patients with previous treatment (66.6%). Conclusions: There is a coincidence of the epidemiological pattern and the resistance pattern shown in the current research with the results of previous national and international studies; these results suggest flaws in the local application of the Programa Nacional de Control y Tratamiento de la tuberculosis. It is recommended to investigate and resolve these flaws, which would have an immediate impact on reducing the incidence of drug-resistant tuberculosis.

RESUMO Introdução: Nos últimos 10 anos, em Cuba e, principalmente, na província de Guantánamo, observou-se um aumento no número de pacientes com tuberculose resistente aos medicamentos; esta é a província com maior incidência no país. Objetivo: Identificar as características epidemiológicas e o padrão de resistência da tuberculose resistente a medicamentos na província de Guantánamo. Método: Foi elaborado um estudo descritivo e transversal que incluiu todos os casos (n=6) com tuberculose resistente a medicamentos diagnosticados entre dezembro de 2010 e dezembro de 2019. Foram estudadas as variáveis: idade, sexo, regime terapêutico, situação econômica, categorias de casos, classificação epidemiológica de resistência e resistência da cepa isolada de acordo com o grau e perfil. Resultados: Houve predomínio do sexo masculino (66,6%) e na faixa etária abaixo de 45 anos (83,3%), a maior quantidade de resistência foi causada por violações nos tratamentos anteriores (66,6%), categorizados principalmente como crônicos e reinternações por abandono. Predominou situação econômica regular (50,0%) e alto nível de alcoolismo (66,7%). A multirresistência prevaleceu em cepas de pacientes com tratamento anterior (66,6%). Conclusões: Há coincidência do padrão epidemiológico e do padrão de resistência mostrado na pesquisa atual com os resultados de estudos nacionais e internacionais anteriores, esses resultados sugerem falhas na aplicação local do Programa Nacional de Controle e Tratamento da Tuberculose. Recomenda-se investigar e resolver essas falhas, que teriam um impacto imediato na redução da incidência de tuberculose resistente aos medicamentos.

Tuberculosis con resistencia a rifampicina en Chile / Tuberculosis with resistance to rifampicin in Chile

Resumen El éxito de los tratamientos acortados de la tuberculosis se debe a la asociación de fármacos bactericidas y esterilizantes, principalmente Rifampicina e Isoniazida. Cuando la Rifampicina no puede ser utilizada por resistencia, los tratamientos son más prolongados y el éxito en la curación se reduce. La resistencia a Rifampicina frecuentemente se acompaña de resistencia a Isoniazida (Multidrogoresistencia o MDR). La OMS informa que en 2019 se diagnosticaron sólo el 44% de los casos estimados de tuberculosis con resistencia a Rifampicina (se proyectaba 465.000 casos) y se trató sólo al 38% de los casos estimados, quedando una gran proporción de casos sin diagnosticar y sin tratar. En Chile la vigilancia de la susceptibilidad a fármacos de primera línea en cepas de Mycobacterium tuberculosis se efectúa mediante biología molecular desde 2014, observándose un progresivo incremento de casos resistentes a Rifampicina desde 1% (23 casos) para ese año hasta 2,2% (65 casos) en 2019. La mayoría de casos de resistencia a Rifampicina corresponden a resistencia inicial. En casos con resistencia a Rifampicina realizamos estudio de susceptibilidad a fármacos de segunda línea en el laboratorio de referencia nacional. La terapia de TB-MDR tradicional tiene baja eficacia, con abandonos frecuentes por su largo tiempo de terapia y toxicidad. Nuevos tratamientos sin inyectables y el uso de Clofazimina, Fluorquinolonas, Linezolid y Bedaquilina tienen una mejor tasa de curación. Recientemente, el Programa de Control de la Tuberculosis de Chile dispone de esta terapia más eficaz y de menor duración por vía oral con estos fármacos.

The high success rate of shortened Tuberculosis (TB) treatments has been achieved by the association of bactericidal and sterilizing drugs. The main drugs are Rifampicin and Isoniazide. When Rifampicin cannot be used by resistance, the treatment is prolonged and success in healing is significantly reduced. Resistance to Rifampicin is often accompanied by resistance to Isoniazide (Multidrug resistance or MDR). WHO reports that only 44% of estimated TB cases with resistance to Rifampicin were diagnosed in 2019 (465,000 cases projected) and only 38% of estimated cases were treated, with a large proportion of cases remaining undiagnosed and untreated. In Chile, monitoring of susceptibility to first-line drugs is conducted in strains of Mycobacterium tuberculosis by molecular biology since 2014, observing a progressive increase in cases with Rifampicin resistance from 1% for that year (23 cases) to 2.2% in 2019 (65 cases). Most cases of resistance to Rifampicin correspond to cases of initial resistance. In cases with resistance to Rifampicin we carry out susceptibility study to second-line drugs in a national reference laboratory. MDR-TB therapy has low efficacy, with frequent abandonments for its long therapy time and toxicity. New non-injectable treatments and use of Clofazimine, Fluorquinolones, Linezolid and Bedaquiline are achieving a better cure rate. Recently, Chile's TB Control Program has this most effective and shorter-lasting oral therapy with these drugs.

Fatores associados à subnotificação de casos de tuberculose multirresistente no Estado do Rio de Janeiro, Brasil: relacionamento probabilístico entre sistemas de informação / Factors associated with underreporting of cases of multidrug-resistant tuberculosis in the state of Rio de Janeiro, Brazil: probabilistic database linkage / Factores asociados a la subnotificación de casos de tuberculosis resistente a múltiples fármacos en el estado de Río de Janeiro, Brasil: relación probabilística entre sistemas de información

Neste estudo, estimou-se a proporção e os fatores associados à subnotificação da tuberculose multirresistente (TB-MDR) no Estado do Rio de Janeiro, Brasil, assim como a proporção de óbitos nesse grupo. Realizou-se um estudo de coorte retrospectiva, utilizando a técnica de relacionamento probabilístico entre sistemas de informação. Os casos com resultado do teste de sensibilidade às drogas (TSA) com padrão TB-MDR registrados no Sistema Gerenciador de Ambiente Laboratorial (GAL), no período 2010 a 2017, foram relacionados com casos notificados no Sistema de Tratamentos Especiais de Tuberculose (SITETB). Regressões logísticas simples e múltipla foram realizadas para estimar os fatores associados à subnotificação. Para verificar o óbito, foi realizada a busca dos casos no Sistema de Informações sobre Mortalidade (SIM) e no portal do Tribunal de Justiça do Estado do Rio de Janeiro. Dos 651 casos TB-MDR no GAL, 165 não haviam sido notificados no SITETB, perfazendo uma subnotificação de 25,4% na amostra. Entre os casos subnotificados, 61 (37%) foram encontrados nos registros de óbito. Na análise múltipla, ter o exame solicitado por um hospital (OR = 2,86; IC95%: 1,72-4,73) esteve associado à subnotificação. No geral, o tempo médio entre a solicitação do exame e a liberação do resultado foi de 113 dias. Entre os casos notificados, o tempo médio entre a solicitação do exame e o início do tratamento foi de 169 dias. Diante disso, é urgente fortalecer as ações de vigilância epidemiológica na TB-MDR, estabelecer e monitorar núcleos de vigilância hospitalar e as rotinas de notificação de TB nos hospitais, rever etapas operacionais, além de unificar os diversos sistemas de informação tornando-os mais ágeis e integrados.

This study estimated the proportion of underreporting of multidrug-resistant tuberculosis (MDR-TB) and associated factors in the State of Rio de Janeiro, Brazil, as well as the proportion of deaths in this group. A retrospective cohort study was conducted using probabilistic database linkage. Cases with the results of the drug sensitivity test (DST) with MDR-TB pattern recorded in the Laboratory Environment Management System (GAL) from 2010 to 2017 were linked to cases reported to the Special TB Treatments System (SITETB). Simple and multiple logistic regressions were performed to estimate factors associated with underreporting. Death was verified by search for cases in the Mortality Information System (SIM) and in the portal of the Rio de Janeiro State Court of Justice. Of the 651 cases of MDR-TB in the GAL, 165 had not been reported to the SITETB, meaning an underreporting rate of 25.4% in the sample. Among the unreported cases, 61 (37%) were identified in the death records. In the multiple analysis, the fact that the test was ordered by a hospital (OR = 2.86; 95%CI: 1.72-4.73) was associated with underreporting. Overall, the mean turnaround time between ordering the test and releasing the result was 113 days. Among reported cases, the mean time between ordering the test and initiating treatment was 169 days. The results underline the urgent need to strengthen epidemiological surveillance activities for MDR-TB, establish and monitor hospital surveillance centers and routine TB reporting in hospitals, review operational stages, and integrate various information systems to make them more agile and integrated.

En este estudio se estimó la proporción y los factores asociados a la subnotificación de la tuberculosis resistente a múltiples fármacos (TB-MDR) en el Estado de Río de Janeiro, Brasil, así como la proporción de óbitos en ese grupo. Se realizó un estudio de cohorte retrospectiva, utilizando la técnica de relación probabilística entre sistemas de información. Los casos con resultado del test de sensibilidad a las drogas (TSA) con patrón TB-MDR, registrados en el Sistema Gerenciador de Ambiente Laboratorial (GAL), en el período 2010 a 2017, se relacionaron con casos notificados en el Sistema de Tratamientos Especiales de Tuberculosis (SITETB). Se realizaron regresiones logísticas simples y múltiples para estimar los factores asociados a la subnotificación. Para verificar el óbito, se realizó la búsqueda de los casos en el Sistema de Información sobre Mortalidad (SIM) y en el portal del Tribunal de Justicia del Estado de Río de Janeiro. De los 651 casos TB-MDR en el GAL, 165 no habían sido notificados en el SITETB, lo que equivale a una subnotificación de un 25,4% en la muestra. Entre los casos subnotificados, 61 (37%) se encontraron en los registros de óbito. En el análisis múltiple, que el examen haya sido solicitado por un hospital (OR = 2,86; IC95%: 1,72-4,73) estuvo asociado a la subnotificación. En general, el tiempo medio entre la solicitud del examen y la llegada del resultado fue de 113 días. Entre los casos notificados, el tiempo medio entre la solicitud del examen y el inicio del tratamiento fue de 169 días. Ante esto, es urgente fortalecer las acciones de vigilancia epidemiológica en la TB-MDR, establecer y supervisar núcleos de vigilancia hospitalaria y las rutinas de notificación de TB en los hospitales, revisar etapas operacionales, además de unificar los diversos sistemas de información haciéndolos más ágiles e integrados.

Trends in primary multidrug-resistant tuberculosis in the State of Rio de Janeiro: a retrospective study conducted during 2000-2019

Abstract INTRODUCTION: We analyzed the trends in primary multidrug-resistant tuberculosis (MDR-TB). METHODS: We performed a time series analysis of primary MDR-TB cases reported in the State of Rio de Janeiro (RJ) during 2000-2019. The annual percent change and the average annual percentage change (AAPC) were computed using joinpoint regression analysis. RESULTS: The percentage of cases increased from 7.69% in 2000 to 38.42% in 2018. We observed an upward trend during this period (AAPC = 9.4; 95% confidence interval 1.4-18.0, p < 0.001). CONCLUSIONS: The trend indicates the increasing occurrence of MDR-TB transmission sources in RJ during 2000-2019.

Transmission and prevalence of drug-resistant tuberculosis in a Brazilian setting under a directly observed therapy short-course strategy

Abstract INTRODUCTION: We aimed to estimate the prevalence and transmission of drug-resistant tuberculosis in a high-burden Brazilian setting under directly observed therapy short-course strategy. METHODS: Isolates of culture-confirmed pulmonary tuberculosis patients from Guarulhos, Brazil, diagnosed in October 2007-2011 were subjected to drug susceptibility and IS6110-restriction fragment length polymorphism testing. RESULTS: The overall resistance prevalence was 11.5% and the multi-drug resistance rate was 4.2%. Twenty-six (43.3%) of 60 drug-resistant isolates were clustered. Epidemiological relationships were identified in 11 (42.3%) patients; 30.8% of the cases were transmitted in households. CONCLUSIONS: Drug-resistant tuberculosis was relatively low and transmitted in households and the community.

Analysis of anti-tuberculosis drug resistance and sociodemographic and clinical aspects of patients admitted in a referral hospital / Análise da resistência a medicamentos antituberculose e aspectos sociodemográficos e clínicos de pacientes atendidos em hospital referência

ABSTRACT Objective To determine the occurrence of anti-tuberculosis drug resistance and its association with sociodemographic and clinical characteristics of patients in a referral hospital. Methods This was a cross-sectional study based on data from patients who had mycobacterial culture identified and defined antimicrobials sensitivity profile (June 2014 to February 2016). The descriptive statistical analysis and Fisher's exact test were used to compare proportions. Results The study included 104 patients who had positive results for Mycobacterium tuberculosis . Bacilloscopy had high positivity (93.3%). A total of 15 patients (14.4%) had resistant strains and six (5.6%) multidrug-resistant. The sociodemographic and clinical characteristics were not related with resistance. Conclusion This study contributed to further the understandings about the tuberculosis patients' profile, the study also served as a tool for development of specific public policies. Patients diagnosed with resistant tuberculosis must be under greater supervision.

RESUMO Objetivo Verificar a ocorrência de resistência a fármacos antituberculose e a associação com características sociodemográficas e clínicas de pacientes de um hospital referência. Métodos Estudo transversal, com dados de pacientes que tiveram a cultura de micobactérias identificada e o respectivo perfil de sensibilidade aos antimicrobianos definido (junho de 2014 a fevereiro de 2016). Foram realizados a análise estatística descritiva e o teste exato de Fisher, para comparação de proporções. Resultados O estudo envolveu 104 pacientes, e todos tiveram resultados para Mycobacterium tuberculosis . A baciloscopia atingiu alta positividade (93,3%), e 15 pacientes (14,4%) apresentaram linhagens resistentes, sendo 6 (5,6%) multirresistentes. As características sociodemográficas e clínicas não foram associadas à resistência. Conclusão A pesquisa permitiu conhecer melhor o perfil dos pacientes com tuberculose e constitui ferramenta para elaboração de políticas públicas específicas. Os pacientes diagnosticados com tuberculose resistente devem ser submetidos à maior supervisão.

Factors associated with tuberculosis and multidrug-resistant tuberculosis in patients treated at a tertiary referral hospital in the state of Minas Gerais, Brazil / Fatores associados à tuberculose e à tuberculose multirresistente em pacientes atendidos em um hospital de referência terciária em Minas Gerais, Brasil

ABSTRACT Objective: To evaluate the risk factors for the development of tuberculosis and multidrug-resistant tuberculosis (MDR-TB) in patients treated at a tertiary referral hospital. Methods: This was a cross-sectional study based on data obtained from patients treated at the Júlia Kubitschek Hospital, located in the city of Belo Horizonte, Brazil, between October of 2012 and October of 2014. We evaluated sociodemographic, behavioral, clinical, and radiological variables. The outcome considered to identify associations between tuberculosis and the explanatory variables was the treatment prescribed. To evaluate the associations between MDR-TB and the same explanatory variables, the change in MDR-TB treatment was considered. Results: The factors associated with tuberculosis were alcoholism, comorbidities, pulmonary cavitations, and a radiological pattern suggestive of tuberculosis. Cavitation and previous treatment for tuberculosis were associated with MDR-TB. Conclusions: Despite the significant progress made in the fight against tuberculosis, there is a need for coordinated actions that include social protection measures and patient support.

RESUMO Objetivo: Avaliar os fatores de risco de pacientes atendidos em um hospital de referência terciária para o desenvolvimento de tuberculose e tuberculose multirresistente (TBMR). Métodos: Estudo transversal baseado em dados obtidos de pacientes atendidos no Hospital Júlia Kubitschek, na cidade de Belo Horizonte (MG), entre outubro de 2012 e outubro de 2014. As variáveis utilizadas foram agrupadas em características sociodemográficas, comportamentais, clínicas e radiológicas. O desfecho considerado para verificar associações entre tuberculose e variáveis explicativas foi o tratamento prescrito para tuberculose. Para avaliar a associação entre a tuberculose resistente e as mesmas variáveis explicativas considerou-se a mudança de tratamento para TBMR. Resultados: Alcoolismo, padrão radiológico sugestivo de tuberculose, presença de comorbidades e presença de cavitações pulmonares foram fatores associados à tuberculose. A TBMR foi associada a tratamento prévio para tuberculose e presença de cavitações. Conclusões: Apesar dos importantes progressos na luta contra a tuberculose, é necessário um conjunto de ações articuladas que incluam medidas de proteção social e suporte aos pacientes.

Avaliação do Sistema de Vigilância da Tuberculose Drogarresistente, Brasil, 2013-2017 / Evaluación del Sistema de Vigilancia de la Tuberculosis Drogorresistente, Brasil, 2013-2017 / Evaluation of the Drug-Resistant Tuberculosis Surveillance System, Brazil, 2013-2017

Objetivo: avaliar o Sistema de Vigilância da Tuberculose Drogarresistente (SV-TBDR)/Brasil. Métodos: estudo avaliativo, segundo diretrizes do Centro de Controle e Prevenção de Doenças, sobre dados nacionais do Sistema de Informação de Tratamentos Especiais de Tuberculose (SITETB) e do Sistema de Informação de Agravos de Notificação (Sinan) de 2013-2017. Resultados: a completitude média dos dados foi de 95% (escolaridade [89,1%; 5.417/6.078]; nacionalidade [94,7%; 5.754/6.078]; raça/cor da pele [99,1%; 6.023/6.078]; tipo de resistência [98,6%; 5.995/6.078]; forma clínica [100%; 6.078/6.078]; e teste para HIV [87%; 5.289/6.078]); a proporção média de casos com culturas realizadas foi de 65,7% (cultura 1 [94,8%; 5.764/6.078]; cultura 2 [69,8%; 4.241/6.078]; cultura 3 [54,7%; 3.324/6.078]; e cultura 4 [43,6%; 2.652/6.078]); em 2015, o SV-TBDR notificou 52% (1.197/2.300) dos casos multirresistentes estimados pela Organização Mundial da Saúde, 41,3% (990/2.400) em 2016 e 45,8% (1.100/2.400) em 2017. Conclusão: a baixa sensibilidade do SV-TBDR recomenda melhorias no acesso ao diagnóstico da TBDR.

Objetivo: evaluar el Sistema de Vigilancia de la Tuberculosis Drogorresistente (SV-TB -DR)/Brasil. Métodos: estudio evaluativo, según directrices del Centro de Control y Prevención de Enfermedades, sobre datos nacionales del Sistema de Información de Tratamientos Especiales de Tuberculosis (SITETB) y del Sistema Nacional de Agravamientos de Notificación (Sinan) entre 2013 y 2017. Resultados: la completitud promedio de los datos fue de 95% (escolaridad [89,1%; 5.417/6.078]; nacionalidad [94,7%; 5.754/6.078]; raza/color de la piel ­[99,1%; 6.023/6.078]; tipo de resistencia [98,6%; 5.995/6.078]; forma clínica [100%; 6.078/6.078]; y prueba de VIH [87%; 5.289/6.078]); la proporción promedio de los casos con cultivos realizados fue 65,7% (cultivo 1 [94,8%; 5.764/6.078]; cultivo 2 [69,8%; 4.241/6.078]; cultivo 3 [54,7%; 3.324/6.078]; y cultivo 4 [43,6%; 2.652/6.078]); el SV-TB-DR reportó en 2015 52% (1.197/2.300) de los casos multirresistentes estimados por la Organización Mundial de la Salud, 41,3% (990/2.400) en 2016 y 45,8% (1.100/2.400) en 2017. Conclusión: la baja sensibilidad del SV-TB-DR sugiere la necesidad de mejorar el acceso al diagnóstico de TB-DR.

Objective: to evaluate the Brazilian Drug-Resistant Tuberculosis Surveillance System (DRTB-SS). Methods: this was an evaluative study, following Centers for Disease Control and Prevention guidelines, using national data from the Special Tuberculosis Treatment Information System (SITETB), and the Notifiable Diseases Information System (SINAN), from 2013 to 2017. Results: average data completeness was 95% (schooling [89.1%; 5,417/6,078], nationality [94.7%; 5,754/6,078], race/skin color [99.1%; 6,023/6,078], type of resistance [98.6%; 5,995/6,078], clinical form [100%; 6,078/6,078], and HIV test [87%; 5,289/6,078]); average proportion of cases with sputum cultures performed was 65.7% (culture 1 [94.8%; 5,764/6,078], culture 2 [69.8%; 4,241/6,078], culture 3 [54.7%, 3,324/6,078], and culture 4 [43.6%; 2,652/6,078]); DRTB-SS reported 52% (1,197/2,300) of multi-resistant cases estimated by the World Health Organization in 2015, 41.3% (990/2,400) in 2016, and 45.8% (1,100/2,400) in 2017. Conclusion: low DRTB-SS sensitivity suggests the need for improved access to DRTB diagnosis.

Lacunas na vigilância da tuberculose drogarresistente: relacionando sistemas de informação do Brasil / Gaps in drug-resistant tuberculosis surveillance: probabilistic database linkage in Brazil / Lagunas en la vigilancia de la tuberculosis resistente a fármacos: relacionando sistemas de información en Brasil

Resumo: O objetivo do trabalho foi avaliar a cobertura e a confiabilidade do encerramento dos casos de tuberculose drogarresistente (TB DR), do Sistema de Informação de Tratamentos Especiais de Tuberculose (SITE-TB), que ocorreram no Brasil no período de 2013 a 2016, a partir de relacionamentos probabilísticos com o Sistema de Informação de Agravos de Notificação (SINAN), Gerenciador de Ambiente Laboratorial (GAL) e Sistema de Informações sobre Mortalidade (SIM). Os casos de TB DR com início de tratamento entre 2013 e 2016 no Brasil constituíram a população do estudo. O relacionamento com o SINAN avaliou a cobertura e estimou a subnotificação dos casos de TB DR. Aplicou-se o método de captura-recaptura, com uso do estimador de Chapman. O relacionamento com o GAL identificou casos diagnosticados pelo laboratório que não estavam notificados no SITE-TB. O relacionamento com o SIM avaliou a confiabilidade do encerramento óbito no SITE-TB, utilizando o coeficiente kappa. Estimou-se uma população de 2.945 (IC95%: 2.365-3.602) casos novos de TB DR com o estimador de Chapman. No GAL, foram encontrados 1.626 indivíduos não notificados no SITE-TB, mesmo com exame laboratorial confirmatório de resistência aos medicamentos antiTB. Classificou-se como excelente, PABAK (prevalance and bias adjusted kappa) de 0,86 (IC95%: 0,85-0,87), a concordância entre o desfecho óbito do SITE-TB e o SIM. Os resultados mostraram que ainda temos lacunas relacionadas ao diagnóstico e ao tratamento da TB DR no Brasil. A subnotificação no SITE-TB de casos de TB DR representa um desafio para o controle da doença. A localização desses indivíduos e o início precoce do tratamento devem constituir uma ação priorizada nos serviços de saúde.

Abstract: The study aimed to assess the coverage and reliability of drug-resistant tuberculosis (DR-TB) case closure in the Information System on Special Treatments for Tuberculosis (SITE-TB in Portuguese) in Brazil from 2013 to 2016, based on probabilistic linkage with the Information System on Diseases of Notification (SINAN), Laboratory Environment Manager (GAL), and Mortality Information System (SIM). The study population consisted of DR-TB cases that initiated treatment from 2013 to 2016 in Brazil. Linkage with SINAN assessed the coverage and estimated underreporting of DR-TB cases. The capture-recapture method was applied, using the Chapman estimator. Linkage with GAL identified cases diagnosed by the laboratory that had not been reported to SITE-TB. Linkage with SIM assessed the reliability of case closure by death in SITE-TB, using the kappa coefficient. We estimated a population of 2,945 (95%CI: 2,365-3,602) new cases of DR-TB with the Chapman estimator. We located 1,626 individuals in the GAL database that had not been reported to SITE-TB, even with laboratory confirmation of drug resistance. PABAK (prevalance and bias adjusted kappa) of 0.86 (95%CI: 0.85-0.87) was classified as excellent for the agreement in death as the outcome between the SITE-TB and SIM databases. The results pointed to persistent gaps related to diagnosis and treatment of DR-TB in Brazil. Underreporting of DR-TB cases in the SITE-TB database poses a challenge for TB control. Identification of these individuals and early start of treatment should be prioritized in health services.

Resumen: El objetivo de este trabajo fue evaluar la cobertura y fiabilidad del cierre de casos de tuberculosis resistente a multiple medicamentos (TB DR; por sus siglas en portugués) en el Sistema de Información de Tratamientos Especiales de Tuberculosis (SITE-TB), que se produjeron en Brasil durante el período de 2013 a 2016, a partir de relaciones probabilísticas con el Sistema de Información de Enfermedades de Notificación (SINAN por sus siglas en portugués), Gestor de Ambiente de Laboratorio (GAL) y Sistema de Información sobre Mortalidad (SIM). La población del estudio fueron los casos de TB DR con inicio de tratamiento entre 2013 y 2016 en Brasil. La relación con el SINAN evaluó la cobertura y estimó la subnotificación de los casos de TB DR. Se aplicó el método de captura-recaptura, utilizando el estimador de Chapman. La relación con el GAL identificó casos diagnosticados por el laboratorio que no estaban notificados en el SITE-TB. La relación con el SIM evaluó la fiabilidad del cierre óbito en el SITE-TB, utilizando el coeficiente kappa. Se estimó que para una población de 2.945 (IC95%: 2.365-3.602) casos nuevos de TB DR con el estimador de Chapman. Se encontraron en el GAL a 1.626 individuos no notificados en el SITE-TB, incluso con examen de laboratorio confirmatorio de resistencia a los medicamentos antiTB. Se clasificó como excelente, PABAK (prevalance and bias adjusted kappa) de 0,86 (IC95%: 0,85-0,87), la concordancia entre el resultado óbito del SITE-TB y el SIM. Los resultados mostraron que todavía existen lagunas relacionadas con el diagnóstico y el tratamiento de la TB DR en Brasil. La subnotificación en el SITE-TB de casos de TB DR representa un desafío para el control de la enfermedad. La localización de esos individuos y el inicio precoz del tratamiento debe ser una acción priorizada en los servicios de salud.

Perfil dos municípios brasileiros, a presença de tuberculose e sua forma drogarresistente / Brazilian cities profile, the occurence of tuberculosis an its drug-resistant form

Resumo A tuberculose tem estreita relação com as condições de vida das pessoas. O presente estudo classifica os municípios brasileiros de acordo com a presença ou ausência de casos de tuberculose (TB) e sua forma drogarresistente (TB-DR), e os descreve quanto às condições de saúde da população, os indicadores de controle da tuberculose, perfil demográfico e socioeconômico. Em 2014, 327 municípios registraram casos de TB-DR. Regiões integradas de desenvolvimento ou regiões metropolitanas concentraram 80,1% dos casos de TB-DR do País. Os municípios com casos de TB-DR tiveram piores indicadores de desfecho da TB, mas maiores percentuais de realização de exame de cultura, além de mais habitantes e melhores indicadores socioeconômicos. Os 3.644 municípios com casos de TB, mas sem casos de TB-DR, tiveram os piores indicadores socioeconômicos entre os três grupos. Os 1.594 municípios sem casos de TB tiveram as menores taxas de desemprego e de detecção de AIDS, e maior cobertura de atenção básica. Os diferentes perfis encontrados no estudo podem dar suporte à lapidação de estratégias nacionais de controle da doença e sua forma drogarresistente no País.

Abstract Tuberculosis is closely related to living conditions. This study classifies Brazilian municipalities according to the occurrence of tuberculosis (TB) and drug-resistant TB (DR-TB) cases and describes them with regard to the population's health conditions, tuberculosis control indicators, demographic and socioeconomic profile. In 2014, 327 municipalities reported DR-TB cases. Integrated regions of development or metropolitan regions accounted for 80.1% of national DR-TB cases. Municipalities with DR-TB cases had worse TB outcome indicators, but higher culture test percentages, and more inhabitants and better socioeconomic indicators. The 3,644 municipalities with TB cases, but without DR-TB cases, had the worst socioeconomic indicators among the three groups. The 1,594 municipalities without TB cases had the lowest rates of unemployment and AIDS detection and greater coverage of primary healthcare. The different profiles found in the study can sustain improved national interventions for TB and drug-resistant TB control in Brazil.

Vigilancia por el laboratorio de la tuberculosis resistente en menores de 15 años, Colombia, 2010 a 2015 / Resistant tuberculosis in children under 15 years of age, Colombia 2010-2015

Resumen Introducción. La tuberculosis en los niños es un reflejo de transmisión reciente en la comunidad. Se estima que en el mundo cada año un millón de niños enferma por esta causa; en Colombia se notificaron 291 casos en el 2015. Objetivo. Actualizar la información obtenida de las actividades de vigilancia por el laboratorio de la farmacorresistencia del bacilo Mycobacterium tuberculosis en menores de 15 años en Colombia entre el 2010 y el 2015. Materiales y métodos. Se llevó a cabo un estudio retrospectivo de corte transversal. Se estudiaron las variables de procedencia, sexo, edad, tipo de tuberculosis y estado de HIV en los casos sensibles y resistentes. Estos se clasificaron como caso nuevo sin tratamiento o caso previamente tratado para analizar el perfil de resistencia a fármacos de primera y segunda línea. Resultados. De los 3.440 casos notificados, en el 16,4 % se practicó la prueba de sensibilidad. El 50,6 % eran mujeres, la forma pulmonar se presentó en el 70,6 % y el 1,4 % presentó coinfección de tuberculosis y HIV. Se estudiaron 565 casos, de los cuales 503 (89,0 %) eran nuevos: el 3,9 % con tuberculosis multirresistente y el 9,5 % con resistencia global. Los previamente tratados fueron 62 (10,9 %), 4,8 % con multirresistencia y 19,3 % con resistencia global. No se evidenciaron diferencias estadísticamente significativas en los años estudiados. La proporción de tuberculosis extremadamente resistente en los casos nuevos evaluados fue de 9,0 %. Conclusiones. Es necesario que el Ministerio de Salud y Protección Social y el Instituto Nacional de Salud promuevan el uso de pruebas diagnósticas rápidas y muy sensibles, como las moleculares recomendadas por la Organización Mundial de la Salud.

Abstract Introduction: Tuberculosis in children is a recent transmission reflection in the community. It is estimated that every year one million children get sick in the world because of this. In Colombia, 291 cases were notified in 2015. Objective: To update the information obtained from the surveillance activities of the drug-resistance laboratory in children younger than 15 years of age in Colombia between 2010 and 2015. Materials and methods: This was a cross-sectional retrospective study. We studied the variables of origin, gender, age, type of tuberculosis, and HIV status in sensitive and resistant cases. We classified them according to their treatment background between new and previously treated to analyze their first and second line drug resistance profile. Results: From the notified cases, 16.4 % had a sensitivity test. 50.6 % were women, the pulmonary form was present in 70.6% cases, and 1.4 % presented with tuberculosis/HIV coinfection. We studied 565 cases, from which 503 (89.1 %) were new, presenting with multidrug-resistant tuberculosis, and a global resistance of 3.9 % and 9.5 %, respectively. From them, 62 had been previously treated (10.9 %), with 4.8 % and 19.3 % multidrug resistance and global resistance, respectively. There was no evidence of statistically significant differences during the studied years. Extremely resistant tuberculosis in new cases was 9.0 %. Conclusions: It is necessary for the Ministerio de Salud y Protección Social and the Instituto Nacional de Salud to promote the use of faster and more sensitive diagnostic tests such as the molecular ones recommended by the World Health Organization.

Situación epidemiológica de la tuberculosis en Chile en el escenario global 2018 / Epidemiological situation of tuberculosis in Chile, 2018

La primera 'Reunión de Alto Nivel de la Asamblea General de las Naciones Unidas ' sobre la lucha contra la tuberculosis se concretó en septiembre de 2018. En ella los Estados Miembros suscribieron compromisos con metas para el año 2022. En Chile, la incidencia de tuberculosis aumentó en 2017, alcanzando 15,6 casos por 100.000 habitantes, con amplia heterogeneidad entre regiones del país. La mortalidad específica por tuberculosis se mantiene estable, alcanzando 1,2 por 100.000 en el año 2016, con importantes diferencias en distribución geográfica. Entre los casos de tuberculosis diagnosticados en 2017, el grupo vulnerable más frecuente fue el de adultos mayores (21,4%), seguido de las personas extranjeras (15,5%). El mismo año se diagnosticaron 37 casos de TB-MDR/RR (multidrogo-resistente y mono resistente a rifampicina), cifra en crecimiento durante el último quinquenio. El índice de pesquisa fue de 22,6, levemente superior al año anterior. Los resultados de la cohorte de tratamiento 2016 para casos nuevos fueron: 78,9% altas, 10,5% fallecidos y 6,6% pérdida de seguimiento. Las cohortes de pacientes antes tratados, coinfectados TB-VIH y pacientes con TB-MDR tienen resultados significativamente peores. Finalmente, la cobertura de estudios de contactos en 2017 fue de 86,4% en general y 91,8% en contactos menores de 15 años. La tuberculosis es un importante problema de salud pública en Chile y el mundo. En 2018 se ha reactivado la agenda internacional de la lucha contra la tuberculosis y se han adquirido nuevos compromisos para acelerar los avances hacia las metas de la Estrategia Fin a la Tuberculosis.

The first High Level Meeting of the General Assembly of the United Nations on ending Tuberculosis was performed in September 2018. In the meeting, the Member States subscribed new commitments and goals for 2022. In Chile in 2017, the tuberculosis incidence rate increased to 15.6 cases per 100,000, with important heterogeneity within geographic regions. Specific tuberculosis mortality rate remains stable, reaching 1.2 per 100,000 in 2016, also with heterogeneity within regions. Among the cases diagnosed in 2017, the most frequent risk group was the elderly (21.4% of cases), followed by foreign migrants (15.5%). In the same year, 37 cases of TB-MDR/RR (multidrug-resistant and Rifampicin-monoresistant TB) were diagnosed, and this number has grown steadily during the last 5 years. Treatment outcomes of the 2016 new cases cohort are as follows: 78.9% completed treatment, 10.5% deceased, and 6.6% lost to follow-up. Results in previously treated patients, HIV-TB co-infected patients, and TB-MDR patients, are significantly worse. The household contacts investigation coverage was 86.4% in all age, and 91.8% in under 15 years old. Tuberculosis remains a relevant public health issue in Chile and globally. The international tuberculosis agenda was reactivated in 2018, and this involved the generation of new global commitments in order to accelerate the accomplishment of the global goals in the End TB Strategy.

Caracterização da tuberculose drogarresistente no Brasil, 2014 / Caracterización de la tuberculosis drogorresistente en Brasil, 2014 / Characterization of drug-resistant tuberculosis in Brazil, 2014

Objetivo: descrever as notificações de tuberculose drogarresistente (TB-DR) no Brasil. Métodos: estudo descritivo de características clínicas e epidemiológicas das notificações de casos de TB-DR em 2014 no SITETB e no TBWeb, sistemas de informações em que são registrados os casos sob esquemas especiais de tratamento. Resultados: foram 1.574 casos, dos quais 94,8% eram pulmonares, 27,6% tinham resistência primária e 50,9% eram multidrogarresistentes; 70,6% eram do sexo masculino, 87,0% tinham entre 20 e 59 anos de idade, 60,9% eram de raça/cor da pele negra e 68,0% contavam com menos de 8 anos de escolaridade; como comorbidades, 13,1% dos pacientes tinham aids, 11,3% diabetes, 25,8% faziam uso prejudicial de álcool, 21,0% usavam drogas ilícitas e 22,2% usavam tabaco. Conclusão: a maioria das notificações de TB-DR era de homens, jovens, negros e com baixa escolaridade; observou-se elevado percentual de resistência primária, assim como de multidrogarresistência e de comorbidades, com ênfase no uso de substâncias.

Objetivo: describir las notificaciones de tuberculosis drogorresistente (TB-DR) en Brasil. Métodos: estudio descriptivo de características clínicas y epidemiológicas de las notificaciones de casos de TB-DR en 2014 en SITETB y TBWeb, sistemas de informaciones donde se registran los casos bajo esquemas especiales de tratamiento. Resultados: fueron 1.574 casos, de los cuales el 94,8% eran pulmonares, 27,6% tenían resistencia primaria y 50,9% eran multidrogorresistentes; el 70,6% era del sexo masculino, 87% tenía entre 20 y 59 años de edad, 60,9% era de raza/color de la piel negra y 68,0% tenía menos de 8 años de escolaridad; como comorbilidad, el 13,1% de los pacientes tenía sida, 11,3% diabetes, 25,8% hacía uso de consumo perjudicial de alcohol, 21,0% utilizaba drogas ilícitas y 22,2% utilizaba tabaco. Conclusion: la mayoría de los casos era de hombres, jóvenes, negros y con baja escolaridad; se observó un alto porcentaje de resistencia primaria, así como de multidrogorresistencia y de comorbilidades, con énfasis en el uso de substancias.

Objective: to describe drug-resistant tuberculosis (DR-TB) notifications in Brazil. Methods: this is a descriptive study of clinical and epidemiological characteristics of DR-TB notifications in 2014 on SITETB and TBWeb, these being information systems on which cases involving special treatment regimens are registered. Results: there were 1,574 cases, 94.8% of which had the pulmonary form, 27.6% involved primary resistance, and 50.9% were multidrug-resistant; 70.6% of cases were male, 87.0% were between 20 and 59 years old, 60.9% were of Afro-Brazilian, and 68.0% had less than 8 years of schooling; as for comorbidities, 13.1% of patients had AIDS, 11.3% had diabetes, 25.8% made harmful use of alcohol, 21.0% were illegal drugs users, and 22.2% were tobacco users. Conclusion: the majority of DR-TB notifications were related to men, young people, Afro-Brazilian and people with low levels of education; there was a high percentage of primary resistance, as well as multidrug-resistance and comorbidities, with emphasis on substance use.

Primary bacillary resistance in multidrug-resistant tuberculosis and predictive factors associated with cure at a referral center in São Paulo, Brazil / Resistência bacilar primária em tuberculose multidrogarresistente e fatores preditivos associados à cura, em um centro de referência da cidade de São Paulo

ABSTRACT Objective: To identify transmitted or primary resistance among cases of multidrug-resistant tuberculosis and predictive factors for cure in multidrug-resistant tuberculosis after the first treatment. Method: Descriptive study of a cohort from 2006 to 2010, in a reference unit of tuberculosis in São Paulo, Brazil. The data were obtained by the revision of medical records. Clinical criteria were used to classify transmitted and acquired resistance. Extended primary resistance was also defined, in this study, as cases initially treated with a standardized scheme, but with no therapeutic success, and the pre-treatment drug susceptibility test (DST) showed presence of resistance. Results: 156 patients with multidrug-resistant tuberculosis and their respective sputum samples were eligible for the study. Only 7% of the patients were positive for the human immunodeficiency virus (HIV). Previous treatment occurred in 95% of the sample. The cure rate after the first treatment was 54%. The median bacteriological conversion time of those who healed was one month. Bacillary resistance was considered acquired resistance in 100 (64%) and transmitted resistance in 56 (36%). By logistic regression, patients who presented primary multidrug-resistant tuberculosis (odds ratio-OR = 6,29), without comorbidity (OR = 3,37) and with higher initial weight (OR = 1.04) were associated with cure after the first treatment. Conclusion: The early detection of bacillary resistance and appropriate treatment are in favor of healing. Thus, it is crucial to know exactly the primary resistance rate avoiding the use of inadequate treatments, amplification of bacillary resistance and its transmission.

RESUMO Objetivo: Identificar resistência transmitida ou primária entre casos de tuberculose multidrogarresistente e fatores preditivos associados à cura da tuberculose multidrogarresistente após o primeiro tratamento. Método: Estudo descritivo de uma coorte de 2006 a 2010, em uma unidade de referência em tuberculose no estado de São Paulo, Brasil. Os dados foram obtidos por meio de revisão de prontuários médicos. Critérios clínicos e laboratoriais foram utilizados para classificar resistência transmitida e adquirida. Resistência primária estendida por definição, neste estudo, abrange também casos inicialmente tratados com esquema padrão, porém sem sucesso terapêutico, e teste de sensibilidade colhido pré-tratamento demonstrou presença de resistência. Resultados: Foram elegíveis para o estudo 156 doentes com tuberculose multidrogarresistente e suas respectivas amostras de escarro. Apenas 7% dos doentes eram positivos ao vírus da imunodeficiência humana (HIV). Tratamento prévio aconteceu em 95% da amostra. A taxa de cura após o primeiro tratamento foi de 54%. A mediana do tempo de conversão bacteriológica dos que se curaram foi de um mês. Dos 156 doentes, 100 (64%) e 56 (36%) foram classificados como resistência adquirida e resistência transmitida, respectivamente. Pela regressão logística, os doentes que se apresentaram com tuberculose multidrogarresistente primária (razão de chance - RC = 6,29), sem comorbidade (RC = 3,37) e com maior peso inicial (RC = 1,04) foram associados ao desfecho cura ao final do primeiro tratamento. Conclusão: A detecção precoce da resistência bacilar e o tratamento adequado favorecem a cura. Dessa forma, é indispensável conhecer com exatidão a taxa de resistência primária evitando o uso de tratamentos inadequados, a ampliação da resistência bacilar e a sua transmissão.

A diagnosis of pulmonary tuberculosis and drug resistance among inmates in Mato Grosso do Sul, Brazil

Abstract INTRODUCTION: High endemic levels of pulmonary tuberculosis in prisons result from overcrowding, limited access to healthcare, delayed diagnosis, sustained transmission owing to poor control measures, and multidrug resistance. This study evaluated locally implemented measures for early pulmonary tuberculosis diagnosis and evaluated resistance to anti-tuberculosis drugs. METHODS: This transversal study employed data from the Mato Grosso do Sul State Tuberculosis Control Program obtained from 35 correctional facilities in 16 counties for 2 periods (2007-2010 and 2011-2014). RESULTS: Statewide prevalence (per 100,000) was 480.0 in 2007 and 972.9 in 2014. The following indicators showed improvement: alcohol-acid-fast bacillus testing (from 82.7% to 92.9%); cultures performed (55.0% to 81.8%); drug susceptibility testing of positive cultures (71.6% to 62.4%); and overall drug susceptibility testing coverage (36.6% to 47.4%). Primary and acquired resistance rates for 2007-2014 were 21.1% and 30.0%, respectively. Primary and acquired multidrug resistance rates were 0.3% and 1.3%, respectively. CONCLUSIONS: Prevalence rates increased, and laboratory indicators improved as a result of capacity building and coordination of technical teams and other individuals providing healthcare to inmates. Resistance rates were high, thereby negatively affecting disease control.

Tuberculosis: renewed challenge in Brazil

Abstract This article reviews tuberculosis control actions performed over the last decade, at a global level. The perspectives for the fulfillment of the goals of the new Global Tuberculosis Elimination Plan are described, where the insertion of social protection (Pillar 2) and research (Pillar 3) will play an innovative and strategic role, especially in high-burden countries, like Brazil.