OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a homeless population with tuberculosis. METHOD This is a qualitative research, conducted in the central region of São Paulo at three basic health units in the period of November to December 2014. A semi-structured interview guideline was implemented for data collection and all interviews were recorded using a digital recorder. RESULTS Six health professionals were interviewed. According to the Discourse Analysis perspective, three discursive segments emerged: experiences on care in the streets; weaknesses inherent to the treatment process; and incentives as a means of maintaining sick people in treatment. CONCLUSION Caring for a the homeless population with tuberculosis constitutes a new and challenging experience. It involves difficulties in dealing with the reality of a miserable social context, a lack and inadequacy of services, as well as care limitations for treatment and treatment dropout, which reinforces multiresistance. However, the investigated Street Clinic teams seek to expand access to health and social care services to this population.

Objective:to describe the epidemiological clinical profile of tuberculosis and analyze the spatial distribution of cases in a municipality in the state of São Paulo. Method:descriptive and ecological study of cases of tuberculosis through the records in an information system. Descriptive statistics were used to calculate central tendency (mean) and chi-square test, with Yates correction or Fisher exact test, when necessary. The Kernel technique was also used to calculate the occurrence densities of tuberculosis cases, using a radius of 1000 meters. Type I error was set at 5%. Results:299 cases of tuberculosis were identified, with 290 (96.98%) being geocoded. The majority of these were male (n = 212; 70.91%), median age 40 years, and the pulmonary clinical form was predominant (n = 244, 81.60%). The distribution occurred in a non-random manner, observing important areas of the municipality with a higher density of cases of the disease. Conclusion:the study evidenced an epidemiological profile of tuberculosis cases similar to those in the literature; however, their distribution does not occur in a random manner, pointing to specific population groups that require greater management and planning of health services for the control of tuberculosis.

Background Tuberculosis (TB) in migrants is of concern to health authorities worldwide and is even more critical in Brazil, considering the country´s size and long land borders. The aim of the study was to identify critical areas in Brazil for migrants diagnosed with TB and to describe the temporal trend in this phenomenon in recent years. Methods This is an ecological study that used spatial analysis and time series analysis. As the study population, all cases of migrants diagnosed with TB from 2014 to 2019 were included, and Brazilian municipalities were considered as the unit of ecological analysis. The Getis-Ord Gi* technique was applied to identify critical areas, and based on the identified clusters, seasonal-trend decomposition based on loess (STL) and Prais-Winsten autoregression were used, respectively, to trace and classify temporal trend in the analyzed series. In addition, several municipal socioeconomic indicators were selected to verify the association between the identified clusters and social vulnerability. Results 2,471 TB cases were reported in migrants. Gi* analysis showed that areas with spatial association with TB in immigrants coincide with critical areas for TB in the general population (coast of the Southeast and North regions). Four TB clusters were identified in immigrants in the states of Amazonas, Roraima, São Paulo, and Rio de Janeiro, with an upward trend in most of these clusters. The temporal trend in TB in immigrants was classified as increasing in Brazil (+ 60.66% per year [95% CI: 27.21–91.85]) and in the clusters in the states of Amazonas, Roraima, and Rio de Janeiro (+1.01, +2.15, and + 2.90% per year, respectively). The cluster in the state of São Paulo was the only one classified as stationary. The descriptive data on the municipalities belonging to the clusters showed evidence of the association between TB incidence and conditions of social vulnerability. Conclusions The study revealed the critical situation of TB among migrants in the country. Based on the findings, health authorities might focus on actions in regions identified, stablishing an intensive monitoring and following up, ensuring that these cases concluded their treatment and avoiding that they could spread the disease to the other regions or scenarios. The population of migrants are very dynamic, therefore strategies for following up them across Brazil are really urgent to manage the tuberculosis among international migrants in an efficient and proper way.

Objective: to analyze the discourse of psychoactive substance users undergoing treatment regarding their image of themselves as drug dependent subjects, of other dependents and the social position assumed by them. Method: qualitative study conducted between March and September of 2016 through a semi-structured interview and drawings, based on the theoretical-methodological reference of French Discourse Analysis. Participation of 12 drug dependent subjects undergoing treatment in the service that substitutes the asylum. Results: The images that psychoactive substance dependents have of themselves and of chemically dependent subjects are associated with the image of a negative, diabolical, transgressive, sick and socially excluded individual. Final considerations: The ideological effects of meanings produced by users’ discourses reproduce the biological and moral model. Health professionals, including nurses, need to invest in discourses that address the psychosocial model to demythologize this stigmatizing image and modify their work practice.

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Objetivo: analisar os sentidos produzidos pelo processo de adoecimento e como eles afetam as pessoas que vivem com tuberculose (TB) e o vírus da imunodeficiência humana (human immunodeficiency virus [HIV]). Método: trata-se de pesquisa qualitativa, com fundamentação teórico-metodológica da Análise de Discurso (AD) de matriz francesa, realizada em um centro de referência para infecções crônicas, no período de janeiro a julho de 2015. Utilizou-se um roteiro de entrevista semiestruturada para a coleta de dados primários. Para a coleta de dados secundários se recorreu ao livro de registro e acompanhamento de tratamento dos casos de TB; ao Sistema de Informação de Agravos de Notificação (SINAN); e ao sistema de controle de pacientes com TB. Resultados: foram entrevistadas 6 pessoas que realizam tratamento para TB e HIV e emergiram 3 blocos discursivos: “Tuberculose e HIV: sentidos circulantes”; “O vínculo paciente-profissional e utilização de incentivos na continuidade do tratamento”; e “Condicionantes que influenciam o processo de adoecimento”. Considerações finais: a concepção de que esses agravos acometem apenas determinados indivíduos se mantém circulante na sociedade, favorecendo o preconceito, diagnóstico tardio e dificuldade de adesão ao tratamento. Assim, fazem-se necessárias políticas públicas e ações de promoção à saúde por parte dos gestores e profissionais da saúde para contribuir com a (des)construção de saberes e o cuidado integral e longitudinal tanto daqueles que estão em tratamento quanto de seus familiares.

RESUMO Objetivo: Relatar a experiência acerca da atuação da/o enfermeira/o junto às equipes de consultório na rua no município de São Paulo/SP Brasil. Método: Estudo descritivo, do tipo relato de experiência, que descreve o cuidado às pessoas em situação de rua, a partir do olhar e da vivência de uma enfermeira. Resultados: Dentre as atribuições das/os enfermeiras/os que atuavam junto às equipes de consultório na rua, destacavam-se o conhecimento acurado do território, habilidade para construção de vínculos, realização de diagnósticos das condições de saúde e epidemiológico, planejamento das ações da equipe, estabelecimento de fluxos de integração junto à Rede de Assistência à Saúde, conhecimento e compreensão sobre a chegada das pessoas às ruas, supervisão das ações dos auxiliares de enfermagem e agentes comunitários de saúde. Conclusão: Atuar como enfermeira/o na equipe de consultório na rua é uma experiência nova e desafiadora que requer dos profissionais ações dinâmicas, estratégicas, criativas e empáticas. A presença de enfermeiras/os nas equipes de Consultório na Rua contribui para a garantia do acesso aos serviços de saúde e cuidado integral, amplia as possibilidades de detecção precoce, tratamento, acompanhamento e a cura de agravos crônicos e infectocontagiosos.