BackgroundTB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil.MethodsA retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT.Results2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08–1.54), cases of relapse (OR = 1.33; 95% CI = 1.03–1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20–1.83), transfer (OR = 2.04; 95% CI = 1.40–2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24–2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16–1.67), and mental disorders (OR = 1.83; 95% CI = 1.38–2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%.ConclusionsThere was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.
Background There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up. Methods This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. Results Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09–1.43), the mother’s self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03–1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26–1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02–1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12–1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24–1.52). Conclusion Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.
Background: There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Loss to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Loss to follow-up is a current problem and has been documented in other countries. This study analyzed the incidence of loss to follow-up of children exposed to HIV and the sociodemographic, behavioral and health variables of associated pregnant women. Methods: This historical cohort study included information on pregnant women living with HIV and the outcome of the child’s exposure to HIV. The association between predictors and the child’s outcome as a loss to follow-up was investigated using the Poisson Regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model. Results: Between 2000 and 2017, of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as loss to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09-1.43), the mother’s self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03-1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26-1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02-1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12-1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24-1.52). Conclusion: Variables related to the individual, social and programmatic vulnerability of pregnant women were evidenced.
Objetivo: Analisar os fatores associados ao abandono do tratamento de tuberculose em pacientes coinfectados por tuberculose/vírus da imunodeficiência humana na capital do Rio Grande do Sul. Métodos: Estudo de coorte retrospectiva conduzido com pacientes com coinfecção por tuberculose/vírus da imunodeficiência humana registrados entre 2009 e 2013. Foram coletados dados demográficos, clínicos, ocorrência de internações e óbito, de três bases de dados nacionais distintas que fazem parte do sistema nacional de vigilância em saúde e utilizou-se a técnica de linkage de dados. Comparações entre os grupos foram realizadas por meio de teste de homogeneidade de proporções baseado na estatística de qui- -quadrado de Pearson ou Fisher para variáveis categóricas, ou teste t de Student ou MannWhitney para variáveis quantitativas. A fim de estimar a razão de chances de cada categoria exploratória de variáveis, foi utilizado o modelo de regressão logística. Resultados: Mantiveram-se associadas ao desfecho maior idade (odds ratio=1,02, intervalo de confiança=1,01–1,03), baixa escolaridade (odds ratio=1,50, intervalo de confiança=1,16–1,92), situação de entrada no serviço como reingresso após abandono (odds ratio=0,25, intervalo de confiança=0,10–0,63) e histórico de internação por complicações relacionadas a tuberculose/vírus da imunodeficiência humana (odds ratio=1,55, intervalo de confiança=1,22–1,96). Conclusão: O abandono de tratamento na capital do Rio Grande do Sul contribui para que o município esteja entre as capitais com um dos maiores índices de tuberculose e de coinfecção por tuberculose/vírus da imunodeficiência humana no Brasil. A situação de entrada no serviço como reingresso após abandono se mostrou um fator de proteção para um novo abandono. As variáveis associadas ao abandono evidenciam os contextos de vulnerabilidade no qual os coinfectados estão inseridos.
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