Fatores preditores para o abandono do tratamento da tuberculose pulmonar preconizado pelo Ministério da Saúde do Brasil na cidade de Porto Alegre (RS)

Abstract

Objective: To determine the predictors of noncompliance with the pulmonary tuberculosis treatment regimen recommended by the Brazilian National Ministry of Health, in previously treatment-naïve patients with active tuberculosis treated in the city of Porto Alegre, Brazil. Methods: This was a case-control study involving six referral primary health care clinics for tuberculosis in Porto Alegre. We reviewed the medical charts of all previously treatment-naïve patients with active pulmonary tuberculosis who were noncompliant with the treatment between 2004 and 2006. Those were paired with other patients having similar characteristics and having been cured. We conducted univariate and multivariate analyses. Results: Of the 2,098 patients included, 218 (10.4%) became noncompliant with the treatment. In the multivariate analysis, the factors most strongly associated with treatment noncompliance were being an alcoholic (with or without concomitant use of illicit drugs), being HIV-infected, not residing with family members, and having a low level of education. In the univariate analysis, treatment noncompliance was also significantly associated with being younger and with being non-White. Gender was not significantly associated with treatment noncompliance; nor was the occurrence of adverse effects of the drugs included in the regimen. Conclusions: In the population studied, being an alcoholic, being HIV-infected, and not residing with family members were the major predictors of noncompliance with treatment for pulmonary tuberculosis among previously treatment-naïve patients. ResumoObjetivo: Determinar os fatores preditores de abandono do tratamento da tuberculose pulmonar, preconizado pelo Ministério da Saúde do Brasil, em pacientes bacilíferos virgens de tratamento atendidos na cidade de Porto Alegre (RS). Métodos: Estudo de caso-controle envolvendo seis unidades básicas de saúde de referência para o tratamento da tuberculose em Porto Alegre, com a revisão dos prontuários de todos os casos de abandono do tratamento por parte de pacientes com tuberculose pulmonar bacilíferos e virgens de tratamento entre 2004 e 2006. Os pacientes incluídos no estudo foram pareados com pacientes com características semelhantes e cujo desfecho foi de cura. Foram realizadas análises univariada e multivariada. Resultados: Dos 2.098 pacientes incluídos no estudo, 218 (10,4%) abandonaram o tratamento. De acordo com a modelo da análise multivariada utilizado, as associações mais significantes para o abandono do tratamento foram o etilismo (com ou sem a concomitância de uso de drogas ilícitas), a infecção por HIV, o fato de o paciente não residir com familiares e o baixo nível de escolaridade. Na análise univariada, indivíduos mais jovens e de etnia não branca também se revelaram significativos para o abandono do tratamento. Gênero e ocorrência de efeitos adversos da medicação não mostraram associação com o abandono. Conclusões: Na população estudada, alcoolismo, infecção por HIV e o fato de o paciente não residir com familiares foram...

The distribution of tuberculosis in Porto Alegre: analysis of the magnitude and tuberculosis-HIV coinfection

“…Still, Porto Alegre failed to achieve these levels, maintaining a low cure rate (both in cases of incidence and prevalence, with 64.5% and 64.2%, respectively) and a high dropout rate (22.1% and 29.5% respectively), not counting the non-performance of DOT in 89.3% of new TB cases, which shows the predominance of adopting the self-administered treatment in the city (5) . This may reflect a disorganized and deficient public health system with only 36.77% of population coverage by the Family Health Strategy (data relative to May 2014) (16) .…”

“…Brazil is among the 22 countries estimated to concentrate 80% of TB cases in the world (5) , recording 71,930 new cases of the disease in the year 2010, in a proportion of 37.7 cases / 100,000 inhabitants (6) . In the country, the homeless, deprived of freedom, indigenous and carriers of Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are considered the most vulnerable populations to the disease (7) .…”

Fatores associados ao abandono do tratamento da tuberculose pulmonar no Maranhão, Brasil, no período de 2001 a 2010

“…O estudo de Campani et al 9 , em Porto Alegre, demonstrou resultados semelhantes: quase 75,9% dos casos tinham 7 anos ou menos de estudo. No estudo de Natal et al 23 (89,7%) e de Severo et al 24 , em São Paulo, o resultado foi de 77,8%.…”

“…A infecção pelo HIV exacerba a epidemia da tuberculose, seja por aumentar a suscetibilidade à infecção pelo Mycobacterium tuberculosis, seja por torná-la uma doença ativa 7,8,9,10 .…”

Vulnerability aspects that hinder tuberculosis healing according to the perspective of patients and healthcare managers

“…Alcohol [29, [32][33][34][35] and drug [29,30] abuse along with smoking [3,33] figure high among these factors.…”