Among all infectious diseases that afflict humans, tuberculosis (TB)

Epidemiological data on tuberculosis and the fight against the disease in Brazil and in the world are reviewed herein. Historical aspects of the different approaches to the control of the disease in Brazil are highlighted and the ongoing Brazilian Program for the Control of Tuberculosis is examined. To conclude, the author takes a look at unresolved problems and considers new alternatives for the control of tuberculosis.

OBJECTIVE:To assess the access to tuberculosis treatment in healthcare services with Programa Saúde da Família (PSF -Family Health Program) and at a reference outpatient clinic. METHODS:A descriptive inquiry was carried out in 2007 with 106 patients who received tuberculosis treatment through the PSF or the reference outpatient clinic in Campina Grande, Northeastern Brazil, from July 2006 to August 2007. To assess the health services, the instrument Primary Care Assessment Tool was used, validated and adapted to assess tuberculosis care in Brazil. The main variables analyzed referred to the transportation and distance to the service and patients' supervision. RESULTS:Of the 106 patients, 83.9% performed self-administered treatment and 16.0% received supervised treatment. The indicators from the PSF units and from the reference outpatient clinic that were similar (p>0.05) were: 65.1% "losing half work day to attend the medical visit"; 65.0% "having to use motorized transport"; 50.0% "always having to pay for motorized transport"; and 69.0% "not receiving treatment at healthcare units near home". The indicators "using motorized transport", "paying for transport to attend the medical visit" and "receiving treatment near home" were statistically different (p<0.05) between the services. Standardized and non-standardized Cronbach's alpha coefficients were, respectively, 0.7275 and 0.7075, based on the eight items of the questionnaire. CONCLUSIONS:Although the city has 85 PSF teams, supervised treatment was carried out by few health workers. Although the tuberculosis treatment is offered by the public health service, it still represents a cost to the patients, due to the distance to the healthcare service and losing half work day in order to attend medical visits.

Background: Smear negative pulmonary tuberculosis (SNPT) accounts for 30% of pulmonary tuberculosis cases reported yearly in Brazil. This study aimed to develop a prediction model for SNPT for outpatients in areas with scarce resources.

A descentralização das ações de controle da Tuberculose para o âmbito da Atenção Primária à Saúde (APS), vem impondo reorientação da prática das Equipes de Saúde da Família (ESF) e requerendo metodologias que avaliem em que medida os componentes da APS estão sendo alcançados. Este estudo toma como recorte um componente da APS-acesso, com o objetivo de avaliar as ações de controle da Tuberculose no contexto das ESF em Bayeux-PB. Pesquisa avaliativa, de abordagem quantitativa, que envolveu 82 profissionais de saúde. O instrumento utilizado continha sete perguntas fechadas, segundo possibilidades produzidas por escala intervalar tipo Likert. Os dados foram tabulados utilizando-se o programa - Statistical Package for the Social Sciences e analisados segundo frequência e mediana. Os resultados revelaram fragilidades e potencialidades de acesso às ações de controle da Tuberculose (TB). Quanto às potencialidades, constatou-se que a descentralização do tratamento dos casos de TB vem se estabelecendo na prática das ESF: 92,7% dos entrevistados mencionaram que os doentes de TB sempre conseguem consulta nas unidades, sendo possível para 82,9% obtê-la no prazo de 24 horas; os medicamentos específicos apresentaram-se acessíveis para 64,6% das ESF. Como fragilidades, verificou-se que 61% dos entrevistados não realizaram coleta de escarro; 54,9% das unidades não oferecem atendimento no horário de almoço; 89,8% dos entrevistados não contam com auxílio transporte; apenas 40,2% das unidades adotam regularmente a visitação domiciliar. Recomenda-se a adoção de mecanismos de gestão que viabilizem a uniformização e utilização dos recursos existentes, ampliando a capacidade resolutiva das ESF, promovendo eficiência na prestação de serviços e assegurando o acesso da população.

Objective: This study aimed to characterize the epidemiological profile of tuberculosis cases reported in the city of Ribeirão Preto between 1998 and 2003, according to patient HIV status, gender, age bracket and treatment outcome. Methods:This was a descriptive epidemiological study that employed the Brazilian National Tuberculosis NotificationDatabase as an instrument of data collection. The study sample consisted of all cases of human immunodeficiency virus/ tuberculosis co-infection occurring in residents of Ribeirão Preto and reported between 1998 and 2003. Results: During this period, 1273 new cases of tuberculosis were reported, 377 of which were in HIV-positive individuals, for a coinfection rate of 30%. Of the cases of co-infection, 76% were in men, and the majority occurred in individuals in the 20-59 age bracket. In terms of treatment outcome, cure was achieved in 52%, treatment abandonment was reported in 11%, and death occurred in 32%. The predominant clinical form of tuberculosis was the pulmonary form, which accounted for 58% of the cases. Conclusion: A high prevalence of co-infection was observed in the community studied.The treatment outcomes seen among the cases in our study sample underscore the need to adopt special strategies to monitor this clientele. Comparing the cases of tuberculosis in isolation with the cases of co-infection, no gender-related or age-related differences were observed.

Care Assessment Tool, developed by Starfield (1) and validated for use in Portuguese in Brazil (2) for the assessment of PHC clinics. Authorization to create an adapted version (based on the original and the translation) was requested from and granted by the authors of the instruments.The present article aims at disseminating and providing access to a questionnaire used as an instrument for assessing the organizational and performance elements of primary health care (PHC) clinics in relation to their role in controlling TB in Brazil. This instrument is adapted from the Primary AbstractThe objective of this study was to provide access to and disseminate a questionnaire used as an instrument to assess the organizational elements and the performance of primary health care clinics regarding TB control in Brazil, comparing selected organizational dimensions by health care clinic, by municipality and by actor (patients, health care workers and managers). The results show that municipalities where the coverage of supervised treatment was more extensive presented more favorable indicators regarding access to TB treatment. The organizational format of the health care clinics involved in TB treatment-family health programs and referral centers with specialized teams in TB control programs (TCPs)-was not a factor that expanded access to diagnosis. The TCPs involving a smaller number of patients presented better performance regarding the health care professional-patient relationship. The majority of the patients faced economic and social difficulties, and most managers were unaware of the amount of resources allocated to TB control activities. The instrument proved to be viable and to have the potential to adequately assess the performance of health care clinics in the urban areas studied.Keywords: Questionnaires; Patient satisfaction; Primary health care; Family health program; Tuberculosis. ResumoO objetivo do estudo foi divulgar e disponibilizar um questionário utilizado como instrumento de avaliação dos elementos organizacionais e de desempenho dos serviços de atenção básica no controle da TB no Brasil, comparando as dimensões organizacionais selecionadas por unidade de saúde, por município e pelos diferentes atores (doentes, profissionais de saúde e gestores). Os resultados mostraram que os municípios com maior cobertura de tratamento supervisionado apresentaram indicadores mais favoráveis para o acesso ao tratamento da TB. A forma de organização da atenção a TB-programas de saúde da família ou unidades de referência com programas de controle da TB (PCT)-não foi um fator que ampliou o acesso ao diagnóstico. Os PCT que atendiam um menor número de doentes apresentaram desempenho mais favorável no que se refere ao vínculo entre o doente e o profissional de saúde. A maioria dos doentes enfrentava dificuldades de ordem econômica e social, e grande parte dos gerentes desconheciam os recursos aplicados nas ações de TB. O instrumento apresentou viabilidade de aplicação e potencial de avaliação dos serviços de saúde nos centro...

Going to primary health care services for diagnosis increased the time before diagnosis of the disease was reached. The Tuberculosis Control Program clinic was more effective in diagnosis of tuberculosis, due to the training of the staff and to an organized process for receiving patients, including the availability of tests to support the diagnosis.