Fatores associados ao abandono e ao óbito de casos de tuberculose drogarresistente (TBDR) atendidos em um centro de referência no Rio de Janeiro, Brasil

Abstract

Drug-resistant tuberculosis (DR-TB) poses a serious threat to tuberculosis (TB) control in Brazil and worldwide. The current study investigated factors associated with loss to follow-up and death in the course of treatment for DR-TB in a tertiary reference center in the city of Rio de Janeiro, Brazil. This was a retrospective cohort study of cases reported to the Information System on Special Treatments for Tuberculosis (SITETB) from January 1, 2012, to December 31, 2013. A total of 257 patients were reported to the SITETB and initiated treatment for DR-TB. Of this total, 139 (54.1%) achieved treatment success as the outcome, 54 (21%) were lost to follow-up, and 21 (8.2%) died. Following a multiple multinomial logistic regression analysis, the age bracket older than 50 years was the only protective factor against loss to follow-up, whereas less than eight years of schooling and reentry after loss to follow-up were considered risk factors. Reentry after loss to follow-up, relapse, and treatment failure appeared as risk factors. Our data reinforce the concept that loss to follow-up in drug-resistant tuberculosis is a serious public health problem, and that adequate follow-up of treatment is necessary in patients with this history and low schooling. A social support network for patients is also indispensable for avoiding unfavorable outcomes.

Avaliação do Sistema de Vigilância da Tuberculose Drogarresistente, Brasil, 2013-2017*

“…Strengthening and decentralizing this surveillance system are goals that have already been achieved, to the extent that the system is comprised of decentralized and integrated workflows, with the participation of health service managers from different government levels and health facilities. Identification of studies and evaluations using SITETB data, 5,10,24,25 as well as stock control and control of medication shipments, which are activities routinely carried out by SITETB, enable the system's usefulness to be recognized.…”

Caracterización socio-epidemiológica y evolución de la tuberculosis en la Región Metropolitana de Chile, 2005 a 2018

“…En cuanto a la terapia anti-TBC, los deficientes resultados y la creciente mortalidad pueden explicarse desde dos aristas: por un lado, las condiciones de vida, la precariedad de la vivienda, co-morbilidades, abuso de drogas y desinformación de algunas personas 31,32 ; y por otro lado, la ejecución de métodos de pesquisa poco efectivos para el contexto, estudio de contacto insuficiente, diagnóstico tardío y una creciente resistencia a farmacológica 27,33 .…”

Evolución de la coinfección por TB/VIH en la Región Metropolitana de Chile, 2005 a 2018

“…Todo aquello, hace aún más preocupante los actuales resultados de la terapia anti-tuberculosis; en la cohorte de pacientes del 2017, se observa que 24,1% abandonó la terapia y 21,5% falleció. En efecto, la coinfección TB/VIH implica per se, un riesgo de letalidad 3 veces mayor que la TB por sí misma 27 , por lo tanto, se requiere de mejores métodos de pesquisa y estudio de contacto más eficientes 1,28 , como por ejemplo la implementación de agentes comunitarios en salud 29 .…”