Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil
Cad. saúde pública
;
23(7): 1573-1582, jul. 2007. tab
Article
in English
| LILACS
| ID: lil-452418
ABSTRACT
A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.
RESUMO
Acompanhou-se uma coorte de casos de tuberculose que iniciou o tratamento entre maio de 2001 e julho de 2003, em Recife, Pernambuco, Brasil, com o objetivo de investigar a associação de fatores biológicos, clínicos, sociais, de hábitos de vida e acesso aos serviços de saúde com falência terapêutica, abandono e óbito, separadamente e de forma agregada. Falência do tratamento esteve associada com demora para o início do tratamento, analfabetismo e consumo de álcool. Associação com o óbito foi encontrada com grupo etário, demora para o início do tratamento, co-infecção pelo HIV e renda do chefe da família. Fatores associados ao abandono foram grupo etário, tratamento prévio para tuberculose e analfabetismo. Os fatores associados aos desfechos de forma agregada foram grupo etário, co-infecção pelo HIV, analfabetismo, consumo de álcool e tratamento prévio para tuberculose. Sugere-se, para aumentar os percentuais de cura, a capacitação continuada das equipes do Programa Saúde da Família para o controle da tuberculose, adaptação das atividades de controle para situações especiais como analfabetismo, alcoolismo e co-infecção pelo HIV, direcionando o uso da terapia diretamente observada para estes grupos de risco.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Patient Dropouts
/
Tuberculosis, Pulmonary
/
Health Services Accessibility
Type of study:
Etiology study
/
Incidence study
/
Observational study
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
South America
/
Brazil
Language:
English
Journal:
Cad. saúde pública
Journal subject:
Public Health
/
Toxicology
Year:
2007
Type:
Article
Affiliation country:
Brazil
/
United kingdom
Institution/Affiliation country:
Fundação Oswaldo Cruz/BR
/
London School of Hygiene and Tropical Medicine/GB
/
Universidade Federal de Pernambuco/BR
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