Panorama internacional e nacional da estratégia do tratamento diretamente supervisionado (DOTS) nas políticas de controle da tuberculose

Abstract

A tuberculose é uma doença infecciosa de grande impacto social causada pelo Mycobacterium tuberculosis. O relatório da Organização Mundial da Saúde (OMS) 2010 estima em 14 milhões o número de pessoas com tuberculose no mundo, com concentração crescente nos países com baixo desenvolvimento social. Em 1993, a OMS lançou o Tratamento Diretamente Supervisionado de Curto Prazo (DOTS), considerado a estratégia mais efetiva no controle da tuberculose em grandes proporções. O DOTS foi introduzido no Brasil em 1998, priorizando cidades com altos índices de casos. Estudos afirmam que houve progresso em diagnóstico, tratamento e rastreamento da tuberculose. O objetivo deste estudo foi revisar a literatura sobre as políticas de controle da tuberculose no mundo e no Brasil, enfatizando a estratégia DOTS. Foram selecionados documentos técnicos da OMS e do Ministério da Saúde do Brasil e artigos científicos nas bases Pubmed e Scielo, estes últimos publicados entre janeiro de 1993 e janeiro de 2010, utilizando-se os descritores: DOTS-plus, treatment, HIV, tuberculosis e DOTS. Foram selecionados 21 artigos científicos de 178 publicações em periódicos e 11 documentos técnicos. Esta literatura enfatiza as políticas de controle da tuberculose no Brasil, no mundo e sua trajetória. Conclui-se que estratégias como o DOTS demandam longo período de adaptação dos profissionais da saúde e dos governos locais, mas já se observa melhora dos indicadores de controle da tuberculose com essas políticas.

Obstacles in the detection and reporting of tuberculosis cases: a discursive analysis

“…In the first discursive block, it is observed that the health professional (MS1), taking the position of manager, is questioned by the circulating senses anchored in the speech that Mozambique is one of the countries with critical problems of laboratories, infrastructures and modern technologies (1,13) . The lack of sufficient laboratories in Sub-Saharan Africa, of which Mozambique is a part, seriously compromises the detection and reporting of TB cases (1,8,13) .…”

“…The lack of sufficient laboratories in Sub-Saharan Africa, of which Mozambique is a part, seriously compromises the detection and reporting of TB cases (1,8,13) . It should be noted that this reality is also present in other countries with high TB burden, such as Nigeria, South Africa and Zimbabwe (1) .…”

“…It should be noted that this reality is also present in other countries with high TB burden, such as Nigeria, South Africa and Zimbabwe (1) . The reporting rate in Mozambique remains only 34%, making it worrying since it makes it impossible to know the true magnitude of the disease (13) . The worldwide TB case detection rate has stagnated by about 60%, failing to reach the target of 70% originally planned for 2000 (1) .…”

“…The senses produced by MS3 subject discourse concerning the difficulty of functioning and coverage of the laboratories and the shortage of evaluation instrument and trained professionals point to the need to elaborate policies that focus the sufficient financing for this activity and the training and qualification of the technicians, aiming in this way to increase the reporting of the cases. The literature emphasizes that managers need to make efforts to capture more resources for action and to obtain new knowledge (1) , which have been of great importance in the detection and reporting of cases (13) . A study carried out in Mozambique revealed that health professionals still have difficulties in knowing about patient characteristics, diagnosis and treatment of TB (14) , a situation that suggests the need for constant training of professionals in this area.…”

Avaliação do tratamento diretamente observado da tuberculose segundo dimensões da transferência de políticas

“…The implementation of this strategy presents some challenges, related to the organization and management of health services, the geopolitical context, and the long period of adaptation required among health professionals and local governments. However, improvements related to this policy can be observed in the TB control indicators, particularly among vulnerable populations such as homeless people, injecting drug addicts and alcoholics (3)(4) . The success of the DOT transfer as a policy is directly related to three dimensions: the information about the DOT received by the professionals who will implement this policy; the knowledge of these professionals about the policy; and innovation, or mode of implementation, of this new policy/ action (5) .…”