Tuberculosis in prison and aspects associated with the diagnosis site.

INTRODUCTION: Tuberculosis (TB) is highly endemic in prison environments, and requires special attention in the population deprived of liberty (PDL). Thus, we aimed to describe the epidemiological situation of TB among PDL in a large municipality of the Brazilian Legal Amazon, from 2012 to 2016, and to identify the factors associated with the site of TB cases notification. METHODOLOGY: Both descriptive and cross-sectional studies were conducted. Sociodemographic, clinical, diagnostic and treatment data of PDL with TB were collected from the National Disease Notification System - SINAN. Data analysis included frequency distribution, Chi-square test, Fisher exact test and residue analysis, with a significance level of 95%. RESULTS: 256 cases of TB have been notified among PDL in the penitentiary complex situated in the municipality and 100 cases in local health services, such as Primary Health Care units or referral services. Notification in the penitentiary complex was associated with non-X-ray and more than ten contacts identified. An association was found between diagnosis in local health services and female sex, AIDS, alcoholism, illicit drug use, extrapulmonary clinical form, extrapulmonary pulmonary disease, suspected X-ray, sputum smear-negative for diagnosis, HIV positive, culture of sputum not performed/ in progress, DOT ignored/ blank, less than five contacts identified, transfer and others as closure situation. CONCLUSIONS: The results show that intricate TB cases were notified by the local health services. Strategies of surveillance and articulation with these health services seem to contribute to the identification of TB cases among PDL.

Health services performance for TB treatment in Brazil: a cross-sectional study.

ABSTRACT: BACKGROUND: Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions. METHODS: This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites. RESULTS: "Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP. CONCLUSIONS: Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.