Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil

Saraceni, Valéria; Pacheco, Antônio Guilherme; Golub, Jonathan E.; Vellozo, Vitoria; King, Bonnie S; Cavalcante, Solange; Eldred, Lois; Chaisson, Richard E.; Durovni, Betina

doi:10.1016/s1413-8670(11)70184-2

Cited by 12 publications

(11 citation statements)

References 14 publications

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“…Our finding is similar to the observation by Saraceni et al 10 who noted non compliance with TB prophylaxis guidelines in brazil and opined that efforts to improve TB control in HIV patients were badly needed. Non compliance with guidelines could be a consequence of poor understanding of the guidelines by the attending clinicians or a communication gap between the wards, the DOTS clinic and the HIV clinic.…”

Section: Discussionsupporting

confidence: 92%

Antiretroviral Drug Substitution Practice in the Treatment Of HIV/TB Co- Infection

Achinge¹

2013

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Section: Discussionsupporting

confidence: 92%

Antiretroviral Drug Substitution Practice in the Treatment Of HIV/TB Co- Infection

Achinge¹

2013

iosrphr

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“…This fact is in concordance with the study of Saraceni et al 17 , who observed the involvement of health care professionals in the treatment of HIV infection, in contrast with the lack of attention that has been paid to the detection and treatment of LTB i in PLWHA. These results, along with those of the present study point to the need for new strategies in order to raise awareness among health professionals working in specialized services for HIV/AIDS for the preventive treatment of tuberculosis.…”

Section: Discussionsupporting

confidence: 91%

“…The involvement of attending physicians is fundamental for patient adherence to treatments and for recognizing behavior known to be associated with non-adherence 17 . In Quebec city, Canada, primary care physicians initiated a substantial number of LTB i treatments, but less than half of patients completed treatment regardless of the physician specialty.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with treatment for latent tuberculosis in persons living with HIV/AIDS

Aquino

Moura

Maruza³

et al. 2015

Cad. Saúde Pública

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The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study’s most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.

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“…Brazil has a high burden of TB in PLHIV 12,13,14 , with most recent estimates stating that 9% of HIV deaths are due to TB 15 . Brazilian guidelines recommending tuberculin skin tests and isoniazid preventive therapy for PLHIV have existed since 1995 16 and recent recommendations from the World Health Organization restate the need for IPT for PLHIV, though evidence in Brazil suggests that physicians do not adhere strictly to these guidelines 17 .…”

Section: Introductionmentioning

confidence: 99%

Prevalent Tuberculosis at HIV Diagnosis in Rio de Janeiro, Brazil

Saraceni

Cohn

Cavalcante

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Although Brazil has model HIV care programs, many patients continue to present late to care. We studied the frequency of tuberculosis (TB) diagnosed at HIV diagnosis in Rio de Janeiro, Brazil, in order to quantify missed opportunities for TB prevention. Methods People living with HIV (PLHIV) and enrolled in the TB/HIV in Rio (THRio) study between 1 September 2005 and 31 August 2009 were included. Prevalent TB was defined as TB diagnosed within 60 days of HIV diagnosis or HIV diagnosis during TB therapy. Survival was measured from HIV diagnosis. We conducted Kaplan-Meier survival plots and Cox regression analyses. Results 4,548 newly diagnosed PLHIV were enrolled; 476(10.5%) with prevalent TB. Prevalent TB cases were older, had lower CD4 counts and higher viral loads than those without TB. Median time to receiving highly active antiretroviral therapy (HAART) in prevalent TB cases was 99 days(IQR=58–191) vs. 126 days(IQR=63–301) in those without TB(p=0.021). Among prevalent TB cases, 17% died during follow-up compared to 8% among non-TB cases(p<0.001). After adjustment for sex, age, baseline CD4 and baseline viral load, risk of death remained significantly higher among prevalent TB cases[aHR=1.72(CI 95% 1.19–2.48)]. Conclusions More than 10% of newly PLHIV in our study presented to care with concurrent active TB disease and thus missed the opportunity for TB preventive therapy. Despite initiating HAART more quickly, these were at significantly greater risk of death. Earlier HIV diagnosis is necessary to provide earlier initiation of HAART and TB preventive therapy to reduce morbidity and mortality in PLHIV.

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Physician adherence to guidelines for tuberculosis and HIV care in Rio de Janeiro, Brazil

Abstract: Physicians are substantially more compliant with HIV monitoring and PCP prophylaxis than with TB prophylaxis guidelines. Efforts to improve TB control in HIV patients are badly needed.

Cited by 12 publications

References 14 publications

Antiretroviral Drug Substitution Practice in the Treatment Of HIV/TB Co- Infection

Antiretroviral Drug Substitution Practice in the Treatment Of HIV/TB Co- Infection

Factors associated with treatment for latent tuberculosis in persons living with HIV/AIDS

Prevalent Tuberculosis at HIV Diagnosis in Rio de Janeiro, Brazil

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