Tuberculosis en el Perú: Situación epidemiológica, avances y desafíos para su control

Abstract

La tuberculosis (TB) es la primera causa de muerte por un agente infeccioso en el mundo, la incidencia en la población viene disminuyendo muy lentamente y la resistencia a los medicamentos es actualmente considerada como una crisis internacional. En el Perú, la reciente Ley de Prevención y Control de la TB en el Perú (Ley 30287), declara de interés nacional la lucha contra la TB. En los últimos años, la Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis (ESNPCT) del Ministerio de Salud (MINSA), ha obtenido avances significativos en el control de esta enfermedad; sin embargo, aún persisten desafíos que deben ser abordados. El presente artículo revisa la situación epidemiológica de la TB en el Perú, sistematiza los avances logrados durante la gestión del equipo de la ESNPCT entre los años 2011 y 2015 desde el abordaje biomédico, de gestión pública y en las determinantes sociales de la salud, además, plantea desafíos para lograr el control de la TB, en el marco de la Ley 30287 y la estrategia "Fin de la TB" de la Organización Mundial de la Salud (OMS). Palabras clave: Tuberculosis; Epidemiología; Administración de los Servicios de Salud; Salud Pública; Perú (Fuente: DeCS BIREME). TUBERCULOSIS IN PERU: EPIDEMIOLOGICAL SITUATION, PROGRESS AND CHALLENGES FOR ITS CONTROL ABSTRACTTuberculosis (TB) is the first cause of death by an infectious agent in the world, the incidence in the population is declining very slowly and drug resistance is currently considered an international crisis. In Peru, the recent TB Prevention and Control Act in Peru (Law 30287) declares the fight against TB of national interest. In recent years, the Ministry of Health's (MINSA) National Health Strategy for the Prevention and Control of Tuberculosis (ESNPCT) has achieved significant progress in the control of this disease; however, challenges still remain to be addressed. This article reviews the epidemiological situation of TB in Peru, systematizes the progress achieved during the management of the ESNPCT team between the years 2011 and 2015 from the biomedical approach, public management and social determinants of health, also posing challenges to achieving TB control under law 30287 and the "End of TB" strategy of the World Health Organization (WHO).

High prevalence of self‐reported tuberculosis and associated factors in a nation‐wide census among prison inmates in Peru

“…Dolan et al estimated the average prevalence of TB in prisons in various continents according to publications from 2005 to 2015, estimating 1977 per 100 000 PDL for Latin America [28], still lower than our findings. This high prevalence found in the Peruvian penitentiary system may indicate that control measures in these settings [8] have not been as effective as in the general population, whose prevalence rates have been declining in recent years thanks to policies implemented by the Ministry of Health [4,5]. The heterogeneous srTB prevalence between prisons could be mainly related to their different overcrowding rates [27] reflected by the large variance contribution to our multivariate models.…”

“…It should be noted that this incidence was 25% higher than in 2013 and 60% higher compared to 2009 . In 2015, the Peruvian National Penitentiary Institute reported an even higher incidence, amounted to 2643/100 000 with 205 confirmed cases of MDR‐TB and five cases of XDR‐TB .…”

Extensively Drug-Resistant Tuberculosis: Report and Literature Review on Two Cases Requiring Prolonged Treatment

“…Peru reports more cases of XDR-TB each year. For example, in 2013 there were 77 cases, 90% of them being from Lima and Callao [4]. In response, The WHO Global Task Force on XDR-TB recommends measures of control and prevention for its management [1].…”

“…XDR-TB has been reported in 105 different countries and is estimated that 10% of these are MDR-TB [1,2]. Peru reported one of the first cases of XDR-TB in 1999 [3], and from 1999 to 2013, 557 cases have been reported, with 79% corresponding to Lima [4]. (3, 4) Additionally, coinfection with XDR-TB and HIV worsens the prognosis of the patients with this condition, increasing the mortality [5].…”

Perú: aún estamos lejos de curarnos de la tuberculosis

“…Las intervenciones sanitarias implementadas en el país para afrontar esta situación aún son insuficientes. El Gobierno Nacional ha incrementado el presupuesto asignado al control de la TB y promulgado la Ley de Prevención y Control de la TB, que dispone la intangibilidad de este presupuesto [2]; sin embargo, las unidades ejecutoras del Ministerio de Salud (MINSA) y la Seguridad Social -como hospitales, regiones de salud e institutos-suelen incumplir esta Ley y disponen del presupuesto asignado para otros gastos.…”