ABSTRACT
SETTING: Treatment default is a serious problem in tuberculosis control because it implies persistence of infection source, increased mortality, increased relapse rates and facilitates the development of resistant strains. OBJECTIVE: This study analyzed tuberculosis treatment default determinants in the Amazonas State to contribute in planning appropriate control interventions. DESIGN: Observational study with a retrospective cohort using Brazilian Disease Notification System data from 2005 to 2010. A nested case control study design was used. Patients defaulting from treatment were considered as 'cases' and those completing treatment as 'controls'. In the analysis, 11,312 tuberculosis patients were included, 1,584 cases and 9,728 controls. RESULTS: Treatment default was observed to be associated to previous default (aOR 3.20; p<0.001), HIV positivity (aOR 1.62; p<0.001), alcoholism (aOR 1.51; p<0.001), low education level (aOR 1.35; p<0.001) and other co-morbidities (aOR 1.31; p = 0.05). Older patients (aOR 0.98; p = 0.001) and DOT (aOR 0,72; p<0.01) were considered as protective factor for default. CONCLUSIONS: Associated factors should be considered in addressing care and policy actions to tuberculosis control. Information on disease and treatment should be intensified and appropriate to the level of education of the population, in order to promote adherence to treatment and counter the spread of multidrug resistance to anti-TB drugs.
Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis/drug therapy , Brazil , Case-Control Studies , Cohort Studies , HumansABSTRACT
No ano de 2003, as ações de controle da Tuberculose foram descentralizadas para a rede básica de saúde de Manaus-AM. A partir dai, os resultados de tratamento apresentaram alto índice de transferência e baixo índice de cura. Foi realizado um Estudo retrospectivo e descritivo com o objetivo de estudar a situação de encerramento dos casos de tuberculose apos o processo de descentralização. Foram revisadas 4.491 fichas de notificação para correção, inserção, exclusão e vinculação de casos. Os registros de 2003 e 2004 foram comparados nas situações antes e depois da revisão. Principais resultados: aumento do percentual de cura de 42,2 por cento para 81,8 por cento no ano de 2003, e de 28,6 por cento para 76,9 por cento, no ano de 2004; diminuição do percentual de transferências de 43,5 por cento para 4,2 por cento em 2003 e de 49,6 por cento para 6,9 por cento em 2004. O estudo contribuiu para a visualização de falhas operacionais e aprimoramento das ações executadas.
In 2003, measures to control Tuberculosis have been decentralized to the primary care network in Manaus, the capital city of the State of Amazon. From that moment on, the results of treatment have shown high transfer rate and low cure rate. A retrospective and descriptive study was done to evaluate the process of closing cases of tuberculosis after the decentralization process. 4,491 notification forms were reviewed for correction, inclusion, exclusion and linkage of cases. The records of 2003 and 2004 were compared before and after the review. Main results: increase in the percentage of cure from 42.2 percent to 81.8 percent in 2003, and from 28.6 percent to 76.9 percet in 2004, decrease in the percentage of transference from 43.5 percent to 4.2 percent in 2003 and from 49.6 percent to 6.9 percent in 2004. The study has contributed to the understanding of operational failures and to improve actions taken.
