Tuberculosis diagnostic pathway in a municipality in south-eastern Brazil.

OBJECTIVE: To analyse the pathway taken by tuberculosis (TB) patients from the first contact with the health services and the diagnosis of TB disease. METHOD: In a survey conducted in a south-eastern municipality of Brazil prioritised for TB control, a structured questionnaire was applied to 100 TB patients under treatment; secondary data recorded in two information systems were also collected for analysis. Diagrams were constructed to represent the patient pathway through the health services up to diagnosis. RESULTS: The emergency services were the point of entry into care for the majority of the patients. Those who first attended primary health care (PHC) centres needed to visit other health services for diagnosis. CONCLUSION: Our study shows that multiple visits to multiple health services are required for the majority of patients to be diagnosed with TB. It is necessary to reinforce the referral path established for TB diagnosis and communication among providers, who should play a clear role in obtaining early diagnosis.

Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view.

SETTING: Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN: A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.

City tuberculosis control coordinators' perspectives of patient adherence to DOT in São Paulo State, Brazil, 2005.

SETTING: Thirty-six priority cities in São Paulo State, Brazil, with a high incidence of tuberculosis (TB) cases, deaths and treatment default. OBJECTIVE: To identify the perspectives of city TB control coordinators regarding the most important components of adherence strategies adopted by health care teams to ensure patient adherence in 36 priority cities in the State of São Paulo, Brazil. DESIGN: Qualitative research with semi-structured interviews conducted with the coordinators of the National TB Control Programme involved in the management of TB treatment services in the public sector. RESULTS: The main issues thought to influence adherence to directly observed treatment (DOT) by coordinators include incentives and benefits delivered to patients, patient-health care worker bonding and comprehensive care, the encouragement given by others to follow treatment (family, neighbours and health professionals), and help provided by health professionals for patients to recover their self-esteem. CONCLUSION: The main aspects mentioned by city TB control coordinators regarding patient adherence to treatment and to DOT in São Paulo are improvements in communications, relationships based on trust, a humane approach and including the patients in the decision-making process concerning their health.

Tuberculosis risks and socio-economic level: a case study of a city in the Brazilian south-east, 1998-2004.

OBJECTIVES: To explore tuberculosis (TB) risks in relation to potential determinants in the city of São José do Rio Preto, São Paulo State, Brazil; to analyse morbidity and mortality indicators in São José do Rio Preto, and to determine the relationship between the risk of TB and socio-economic level (SEL) using a geo-referenced information system (GIS) and the national census for 2000. METHOD: Standardised incidence rates and TB incidence and mortality rates were calculated. Socio-economic variables were determined using the statistical technique of principal component analysis. Data sources were the São Paulo State Data Analysis System (SEADE), the TB Notification Database (EPI-TB), the Information Department of the Brazilian Health Ministry (DATASUS), and the Brazilian Institute of Geography and Statistics (IBGE). New cases reported in 1998-1999 and 2003-2004 in the urban area of the city were geo-referenced and analysed. RESULTS: TB risk in the city is twice as high in areas of lower SEL than in areas with higher SEL. CONCLUSION: The identification of areas with different levels of risk enables the Municipal Health Department to propose innovative interventions to minimise the risk of disease at both individual and population level.

Survey on tuberculosis teaching in Brazilian nursing schools, 2004.

OBJECTIVE: To characterise tuberculosis (TB) teaching in Brazilian nursing schools by state and region and its theoretical and practical contents. METHODOLOGY: In an educational research survey in 2004, 347 nursing schools were identified. Questionnaires were posted to faculties providing training in TB. Data were compiled in a database with a view to descriptive result analysis. Replies to the questionnaire were received by 32% of the nursing schools contacted. RESULTS: Undergraduate TB teaching is heterogeneous. For training in theory, the principle teaching method is through classes in 102 (91.9%) nursing schools. Practical TB teaching is carried out at the primary care level (89.2%). Teachers update their knowledge through events and internet; little reference is made to manuals. The time devoted to practical TB teaching ranges from 10 to 20 hours, although this is not always included in student training. CONCLUSION: Teaching in TB should go beyond the traditional model that focuses only on biological aspects. It should introduce tools that lead to permanent behavioural change, such as a more human approach and social and psychological aspects, such as living conditions, habits and customs. It should involve new partners, such as families, communities and other health professionals, and identify obstacles within the university.