BackgroundTuberculosis remains an important disease which mainly affects the majority of vulnerable individuals in society, who are subjected to poor living conditions and difficulties to access the services of public health. Under these circumstances, the present study aims to understand patients’ perception in relation to the influence of individual and social vulnerabilities on the adherence to tuberculosis treatment.MethodsA qualitative descriptive cross sectional study was conducted in one large municipality at the state of Paraíba, Northeast of Brazil. The study subjects, who were residents of the study site, covered all tuberculosis cases diagnosed between March and June 2015. The sample was defined by the criteria of response saturation. All interviews were audio recorded, and data analysis was developed through the hermeneutic dialectic method and the theory of Generative Route Sense. The project was approved by the Research Ethics Committee of the University of São Paulo (USP).ResultsA total of 13 individuals were interviewed and the responses were identified into two analytical categories: the difficulties they had and the enabling factors they could mention during their tuberculosis treatment. Patients brought up social exclusion as an obstacle to treatment adherence, which, along with stigmatization, weakened their link with family members and health professionals. Moreover, economic precariousness was a major hindrance to the maintenance of a proper diet and transportation access to health centers. However, social support and directly observed treatment helped to break down barriers of prejudice and to promote individual and family empowerment. Finally, patients also reported that their will to live and faith gave them the strength to continue with the treatment.ConclusionsAccording to patients in this study, social support and the strengthening of links with family members and health professionals may reduce social exclusion and other difficulties they face, thus encouraging them to the adhere to tuberculosis treatment.
A coinfecção tuberculose-HIV configura-se como um desafio para a saúde pública, principalmente nas regiões em desenvolvimento socioeconômico. O objetivo deste estudo é identificar aspectos sociais, de saúde-doença e de cuidado em saúde de pessoas acometidas com a coinfecção tuberculose-HIV que realizaram o tratamento da tuberculose. É um estudo transversal, realizado em dois municípios brasileiros de grande porte, localizados no estado da Paraíba. Teve como população todos os doentes coinfectados com tuberculose-HIV com diagnóstico e tratamento da tuberculose em 2016. Com amostra censitária, participaram 35 pessoas. Os dados foram de julho a outubro de 2017, a partir de entrevistas semiestruturadas, com questionário que contemplou variáveis sociais, de saúde-doença e de cuidado em saúde. A análise bivariada foi realizada através do SPSS v.13.0. Houve predominância do sexo masculino, da fase adulto-jovem, baixa escolaridade, com exposição à violência, do impedimento de realizar atividades ocupacionais após o adoecimento, diagnósticos tardios da tuberculose e realizados em hospitais públicos. Os casos novos, a forma pulmonar, cura da tuberculose e a falta de antituberculostáticos e antirretrovirais também foram evidenciados. A exposição à violência, o afastamento de atividades ocupacionais e a falta de medicamentos durante o tratamento foram achados inéditos e configuram-se como desafios que provavelmente desfavorecem a adesão terapêutica e dificultam o controle de ambos os agravos. Esses resultados revelam a necessidade de ações intersetoriais, com o objetivo de desenvolver ações estratégicas que contribuam para a redução das desigualdades sociais e, consequentemente, para o controle dos agravos.
Introduction: Brazil has high levels of TB-AIDS co-infection.Objective: To analyse differences and similarities, with respect to each State in Brazil and to the Federal District, concerning the stage at which TB-AIDS co-infection treatment is discontinued. The study period was 2008-13. Methods:Cross-sectional, quantitative study, using data from the Diseases and Notification Information System administered by the Brazilian Health Ministry. The data were analysed using the statistics program R, and the results are represented graphically by dotplots and dendrograms.Results: 58,704 cases of tuberculosis-AIDS co-infection were recorded. Rates of cure were under 30%. In the States of Paraíba and Pernambuco, treatment dropout was almost 50%.Mortality levels were high, at 70-90% in some States. Multiresistant TB was observed in less than 20%of cases. The rate of non-treated/non-resolved cases was 70% in Bahia. Transfer rates varied widely, with the highest level being recorded in Alagoas (80% of cases). Conclusion:Global goals are far from being met. There is considerable operational diversity in the public health policies of the different States. TB-AIDS co-infection should be monitored continuously and the epidemiological information system regularly updated in order to control this double epidemic.
RESUMOObjetivo Avaliar as ações de controle da tuberculose realizadas em um município brasileiro de grande porte. Métodos Estudo transversal analítico de abordagem quantitativa, cuja população (N=137) abrangeu os doentes com tuberculose notificados no Sistema de Informação de Agravos e Notificação e que estavam em tratamento, com amostra (n=75) obtida após os critérios de inclusão e de exclusão. As variáveis estudadas foram: "unidade de saúde responsável pelo diagnóstico da tuberculose", "tempo gasto para receber o diagnóstico da tuberculose, após o início dos sinais e sintomas", "unidade de saúde responsável pelo tratamento da tuberculose" e "tipo de tratamento da tuberculose". Os dados foram obtidos a partir de entrevistas estruturadas e analisados por meio da estatística descritiva e analítica com a aplicação do Teste Qui Quadrado de Pearson, através do software R. Conclusão O estudo identificou que as ações de controle da tuberculose encontram-se centralizadas nos serviços especializados e na rede privada, o que contribui para o diagnóstico tardio e dificulta a quebra da cadeia de transmissão da doença, além do tratamento autoadministrado, modalidade que favorece o desfecho antagônico do tratamento. Palavras-chave:Tuberculose; avaliação; serviços de saúde (fonte: DeCS, BIREME).
Setting: The situation of tuberculosis in Brazil, in each of its States and in the Federal District, with respect to patients' level of education. Objective: To assess the strength of the relation between new cases of tuberculosis and treatment outcomes and rates of abandonment, with respect to the patients' level of education, in 2013. Design: Transversal-quantitative study, using data from the Brazilian Disease and Notification Information System related to notified cases of tuberculosis, taking into account the patients' level of education. Data were analyzed by the hierarchical classification method (heat maps and dendrograms). Results: In relation to numbers of new cases of tuberculosis and rates of healing and treatment abandonment, the lower the patients' level of education (less than 9 years' formal education), the higher the numbers of new cases of tuberculosis and the higher the rates of healing and treatment abandonment, throughout the country. Levels of schooling of 1-5 years and of 6-9 years are especially strongly related to a high incidence of treatment abandonment, in all the States. This nding was con rmed by clustering techniques. Treatment abandonment is especially prevalent in the States of São Paulo, Rio Grande do Sul and Rio de Janeiro, according to both analytic methods. In the States of Minas Gerais, Espírito Santo, Mato Grasso do Sul and Paraná, have the problem more similarly, but mixed with other groups of States. Conclusion: Knowledge of the level of education of tuberculosis patients is of vital importance to health care managers, enabling them
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