Social determinants of health and catastrophic costs associated with the diagnosis and treatment of tuberculosis

Moreira, Adriana da Silva Rezende; Kritski, Afrânio Lineu; Carvalho, Anna Cristina Calçada

doi:10.36416/1806-3756/e20200015

Cited by 33 publications

(19 citation statements)

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“…Thus, TB and poverty maintain a dependent relationship, as poverty can be associated with precarious health conditions. Also, these two can produce poverty by reducing opportunities for work and subsistence [30].…”

Section: Discussionmentioning

confidence: 99%

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

Souza

Santos

Crispim

et al. 2021

BMC Health Serv Res

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Background Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. Methods We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study’s theoretical framework. Results The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. Conclusion The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.

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Section: Discussionmentioning

confidence: 99%

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

Souza

Santos

Crispim

et al. 2021

BMC Health Serv Res

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show abstract

“…During the interviews, many professionals reported that the fact that the patient has progressed to MDR-TB is often due to the social class in which he / she is inserted, stating that low-income population groups are more likely to fall ill. Knowing that poverty is one of the most important determinants of TB, it can also worsen the health condition of individuals [26]. Thus, TB and poverty maintain a dependency relationship, as poverty can be associated with precarious health conditions, as these can produce poverty, by reducing opportunities for work and subsistence [27].…”

Section: Discussionmentioning

confidence: 99%

Multidrug-resistant tuberculosis from the health providers’ perspective: strategies for compliance and equity in seeking the care in COVID-19 era (Brazil, 2020)

Souza

Santos

Crispim

et al. 2021

Preprint

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BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) itself is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perception of health professionals about multidrug-resistant tuberculosis, their strategies to ensure adherence to treatment and the challenges in the context of the COVID-19 pandemic, in a priority municipality for disease control in the state of São Paulo, Brazil. METHODS: We conducted a qualitative study and recruited fourteen health professionals, four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker, working in the Ribeirão Preto health system. Remote semi-structured interviews were conducted with these professionals. For data analysis, Thematic Content Analysis was applied according to the theoretical framework defined for the study. RESULTS: The findings showed the relationship between poverty, inequality and MDR-TB. Concerning the COVID-19 pandemic, reports from professionals show an interference in the monitoring of patients. As for social protection and the benefits that covered the patients, they were cut. Professionals also reported concerns about obtaining COVID-19 and adopting strategies to ensure adherence, as well as reinforcements of the DOTS strategy. CONCLUSION: The study advances in knowledge by highlighting the challenges faced by the health system for the adherence of MDR-TB patients in a context aggravated by Pandemic. The strategies defined by these health professionals have somehow guaranteed the achievement of equity and avoided the catastrophic encounter between TB-MDR and COVID-19.

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“…The world distribution of TB cases is unequal, for instance, in 2018, Asia was responsible for 44% of all new cases, Africa for 24%, America for 3% and Europe, 3% (2). This geographical distribution illustrates that tuberculosis is a socially mediated disease 3 .…”

Section: Introductionmentioning

confidence: 90%

Tuberculosis treatment adherence in homeless population: an overview and policy dialogue

Elias

Pereira²,

Gallo

et al. 2020

Com. Ciências Saúde

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Objective: we conducted an overview of systematic reviews aiming to describe the existing interventions to increase the adherence to the TB’s treatment by homeless people. Methods: The effects and local applicability of these interventions in Brazil were obtained in a policy dialogue with stakeholders. Results: Four interventions were effective: Financial incentives; Housing; Case management Programs; Assertive community treatment. Conclusion: It is recommended to combine all interventions to achieve effectiveness.

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Social determinants of health and catastrophic costs associated with the diagnosis and treatment of tuberculosis

Cited by 33 publications

References 0 publications

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

Multidrug-resistant tuberculosis from the health providers’ perspective: strategies for compliance and equity in seeking the care in COVID-19 era (Brazil, 2020)

Tuberculosis treatment adherence in homeless population: an overview and policy dialogue

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