Factors Associated with the Abandonment of Tuberculosis Treatment in Brazil: A Systematic Review

Abstract

Background: Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis . In Brazil, TB is a public health problem, and the treatment dropout rate contributes to it. Methods: This systematic review investigated the factors associated with TB treatment dropout in Brazil using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The databases used were Bireme, Scopus, PubMed, Medline, Pan-American Health Organization (PAHO), and Latin-American and Caribbean Literature on Health Sciences (LILACS). The search was conducted on May 16, 2021. Nine articles were reviewed, and all were published within the last 5 years in English, Spanish, or Portuguese. Results: The sample sizes in the studies ranged from 148 to 77,212 individuals, and the studies enrolled only adult patients (aged 18-59 years) in Brazil. Evidence suggests that the significant risk factors associated with TB treatment dropout are male sex, black race/ethnicity, age between 19 and 49 years, human immunodeficiency virus (HIV) co-infection, low education (<8 years), use of alcohol and illicit drugs, and unsupervised treatment. This study’s limitations were the small number of articles published on this topic with stronger study designs, use of secondary data sources in most articles, and a moderate to high risk of bias in most papers. Conclusions: There was a significant association between abandonment of TB treatment and HIV/acquired immunodeficiency syndrome co-infection; socioeconomic factors (low education and homelessness); use of alcohol, tobacco, and illicit drugs; and failure to use directly observed treatment. These results can guide more efficient measures to prevent dropout.

Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records

“…Both factors were found to be important for individuals with no education or limited education. These findings are consistent with previous systematic reviews and meta-analyses [11][12][13], and point to the greater challenges of achieving successful treatment outcomes for medically fragile individuals, and for individuals with vulnerable circumstances or health behaviors that make it more difficult to complete the extended treatment regimens required for TB disease. Treatment completion was found to be higher among incarcerated patients, consistent with earlier studies [12,16,17].…”

“…These findings are consistent with previous systematic reviews and meta-analyses [11][12][13], and point to the greater challenges of achieving successful treatment outcomes for medically fragile individuals, and for individuals with vulnerable circumstances or health behaviors that make it more difficult to complete the extended treatment regimens required for TB disease. Treatment completion was found to be higher among incarcerated patients, consistent with earlier studies [12,16,17]. However, TB treatment completion among incarcerated individuals may be eroded when patients are transferred between facilities or released during treatment, as coordination of care is often challenging [17].…”

Mycobacterium tuberculosis in a Trap: The Role of Neutrophil Extracellular Traps in Tuberculosis

“…Tuberculosis (TB) is an infectious-contagious disease mainly affecting the lungs and other tissues [1]. Several factors have limited TB control, including timely diagnosis and treatment, imperfect diagnostic testing, multi-drug resistance, and treatment abandonment [2][3][4][5]. Countries with a high burden of tuberculosis utilize Bacille Calmette-Guérin (BCG), a vaccine based on an attenuated strain of Mycobacterium bovis, to mitigate the risk of severe TB manifestations, such as meningitis and disseminated TB, in children.…”