Sociodemographic and clinical characteristics are determinants of anti-tuberculosis treatment outcomes in patients undergoing DOT; DOT use led to a 25% reduction in unfavorable outcomes.

IntroductionThe number of subjects with tuberculosis (TB) presenting with co-occurrence of multiple chronic medical conditions, or multimorbidity (MM) is increasing in Brazil. This manuscript aimed to characterize subjects with TB, according to their MM status and to analyse factors associated with TB treatment outcomes.MethodsThis is a cross-sectional study that included 39,881 TB subjects reported in Brazil, in 2011. MM were defined as any (two or more) occurrence of chronic medical conditions in a TB patient (TB–MM). Data analysis was performed by hierarchical logistic regression models comparing TBMM with those with only TB.ResultsOf the reported TB cases in 2011, 454 (1.14%) had MM. The subjects in the age group 40–59 years (OR: 17.89; 95% CI, 5.71-56.03) and those ≥ 60 years (OR: 44.11; 95% CI, 14.09-138.06) were more likely to develop TB–MM. The TB–MM subjects were less likely to be male (OR: 0.63; 95% CI, 0.52-0.76), institutionalized (OR: 0.59; 95% CI, 0.23-0.80) and live in rural areas (OR: 0.63; 95% CI, 0.42-0.95). Death from causes other than TB was higher among TB–MM subjects (OR: 1.76; 95% CI, 1.36-2.28). Of 454 TB–MM subjects 302 (66.5%) were cured and 152 (33.5%) were not cured. The odds of not being cured was 1.55 (95% CI, 1.04-2.32) among males, 2.85 (95% CI, 1.12-7.28) among institutionalized subjects, and 3.93 (IC 95%, 1.86-8.30) among those who were infected with HIV. TB retreatment after previous abandonment (OR: 7.53; 95% CI, 2.58-21.97) and transfer from a treatment site (OR: 2.76; 95% CI, 1.20-6.38) were higher for subjects not cured compared to those who were cured.ConclusionsWhile TB is well recognized to be a disease engendered by social inequity, we found that even among TB patients, those who have MM have greater inequity in terms of socioeconomic status and adverse clinical outcomes. Addressing the problem of TB and TB–MM requires a multisectorial approach that includes health and social service organizations.

TB in the imprisoned population presents some specific characteristics and higher occurrence than in the general population; the highest prevalence in women and the highest incidence at the end of the study period stood out.

Our results highlight the need to improve TB control and policies in correctional facilities. Improving treatment outcomes of prisoners will also prevent transmission to other prisoners, their family members, and health professionals.

OBJETIVOS: Calcular a taxa de casos diagnosticados com tuberculose por unidades prisionais do Espírito Santo, apresentar as características individuais, clínicas e institucionais dos casos na população privada de liberdade (PPL) do ES e analisar a associação entre essas características e o encerramento do tratamento da tuberculose nessa população. MÉTODOS: A população de estudo foram os casos de tuberculose na PPL do ES de 2014 a 2016. Realizou-se o cálculo de taxa, a análise descritiva e a regressão logística hierarquizada considerando os níveis individual, clínico e institucional. RESULTADOS: A taxa de casos diagnosticados por unidade prisional no estado variou de 0 a 17,3 casos por 1.000 presos. Do total de casos notificados, 218 (72,6%) se curaram, 21 (7,0%) abandonaram o tratamento, 1 (0,3%) morreu por tuberculose, 2 (0,7%) morreram por outras causas, 56 (18,7%) transferiram o local de tratamento e 2 (0,7%) desenvolveram tuberculose drogarresistente. A análise ajustada mostrou que o tratamento supervisionado é um fator protetor para o insucesso (RC = 0,29; IC95% 0,01–0,76). CONCLUSÕES: O estudo apontou a importância do conhecimento do desfecho do tratamento da TB na PPL visando à implementação de ações para a redução do insucesso, bem como a contribuição do tratamento supervisionado nesse processo. DESCRITORES: Prisioneiros. Tuberculose, epidemiologia. Tuberculose Resistente a Múltiplos Medicamentos, epidemiologia.

A instituição criteriosa de terapia antirretroviral, no tratamento de Aids é conduta importante, no sentido de proporcionar maior sobrevida aos pacientes 6 .No entanto, em crianças cuja transmissão vertical foi diagnosticada um dos grandes problemas apontados é a resposta sustentada da terapia, relacionada à potência, tolerância e possibilidade de boa qualidade de vida durante o tratamento da Aids 7 . Preditores de mudanças nos regimes terapêuticos para o tratamento de Aids em criançasPredictors of changes in drug regimens for treating AIDS in children ABSTRACTTo identify the causes of changes in therapeutic regimens for treating AIDS in children infected through vertical transmission. This was a case-control study in which the control group consisted of 49 children who had not had any changes to their antiretroviral regimen and the case group consisted of 62 children who had had changes between January 2000 and December 2005. Data from the patients' medical files and a semistructured interview were used. The data analysis was carried out using the SPSS software, and the chi-square test and logistic regression were applied. The main causes of changes in treatment were: increased viral load (48.4%), poor immunological response (46.6%) and clinical worsening (35.5%) of the patients. The adjustment of the data through logistic regression analysis showed that drug intolerance was the variable that contributed most to the change in medication ( adjusted OR: 79.94; 95% CI: 6.28 -1034.55). Adherence was not shown to be responsible for changes in the anti-retroviral therapy, and this was attributable to the organization of the service and actions of the interdisciplinary team.Key-words: Aids. Children. Treatment. Failure. Adherence.Alguns obstáculos são frequentemente responsáveis pela diminuição da resposta sustentada ao tratamento: a condição clínica do paciente, a de piora imunológica, o aumento da carga viral, que em conjunto ou individualmente são responsáveis pela determinação de falha terapêutica de esquema antirretroviral 1 .A intolerância aos antirretrovirais, outra determinante para troca de esquema, é considerada quando o paciente mostra impossibilidade absoluta de uso do medicamento, apresentando efeitos colaterais incompatíveis com a qualidade de vida 2 . Além disto, a falha terapêutica, também pode estar relacionada com a adesão ao tratamento e essa possibilidade sempre deve ser investigada 10 .Os regimes terapêuticos disponibilizados pelo Ministério da Saúde para crianças em tratamento de Aids podem ser agrupados em três classes de medicamentos: 1ª) Inibidores de fusão (efurvitida: não estava disponível à época do estudo). 2ª) Inibidores da transcriptase reversa (análogo de nucleosídeo: estavudina, lamivudina, tenofovir e zidovudina; não-análogo do nucleosídeo: efavirenz e nevirapina). 3ª) Inibidores da protease (amprenavir, atazanavir, indinavir, lopinavir/ritonavir,

Objetivo: Estimar a prevalência de infecção por SARS-CoV-2 entre trabalhadores do sistema prisional do Espírito Santo, Brasil, no período agosto-setembro de 2020. Métodos: Inquérito em amostra estratificada, mediante entrevistas e testes sorológicos para SARS-CoV-2. Resultados: Nos 986 pesquisados, a prevalência deinfecção por SARS-CoV-2 foi de 11,9% (IC95% 8,1%;15,7%) nos profissionais de saúde, e de 22,1% (IC95%; 18,8%;25,3%) nos agentes penitenciários. A positividade foi mais frequente nos profissionais da saúde do norte do estado (19,7%) e em agentes penitenciários do sexo masculino (24,0%). Entre soropositivos, a fadiga foi o sintoma mais frequente nos agentes penitenciários (13,4%) e a mialgia nos profissionais de saúde (10,8%); e as comorbidades mais prevalentes entre os positivos foram asma ou bronquite (16,2%), para profissionais de saúde, e hipertensão para agentes penitenciários (12,8%). Conclusão: A prevalência de SARS-Cov-2 foi maior nos agentes penitenciários, achado que deve subsidiar ações de controle e prevenção dadoença nesse cenário.

Objectives: to estimate the prevalence of SARS-CoV-2 infection in residents of the Greater Vitória region living in subnormal and non-subnormal agglomerates, and to compare sociodemographic and clinical characteristics of total residents (infected and not infected with SARS-CoV-2) between them. Methods: Population-based prevalence study conducted by serological testing in 2020, with a study unit in households in Greater Vitória, grouped into census tracts classified as sub-normal agglomerates and non-sub-normal agglomerates. The two groups were compared in terms of prevalence and associated factors. The significance level adopted was 5%. Results: The prevalence found in the sub-normal clusters was 12.05% (95%CI 9.59–14.50), and in the non-sub-normal clusters 10.23% (95%CI 7.97–12.50) this difference was not statistically significant (p = 0.273). Comparing the sociodemographic characteristics, more people who declare themselves to be of mixed race were found in the sub-normal clusters, a higher percentage of illiterates and people with only elementary education, greater number of residents per household, longer stay in public transportation, sharing a bathroom with another household, fewer bedrooms per residence and higher frequency of irregular water supply when compared to non-sub-normal clusters (p < 0.05). Conclusions: The epidemiological characteristics of sub-normal clusters’ residents show the social inequalities that can hinder control measures in a pandemic situation.