Tuberculosis: renewed challenge in Brazil

Kritski, Afrânio Lineu; Andrade, Kleydson Bonfim; Galliez, Rafael Mello; Maciel, Ethel Leonor Nóia; Cordeiro-Santos, Marcelo; Miranda, Silvana Spíndola de; Villa, T S; Netto, Antônio Ruffino; Arakaki-Sanchéz, Denise; Croda, Júlio

doi:10.1590/0037-8682-0349-2017

Cited by 22 publications

(15 citation statements)

References 30 publications

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“…Substantial progress has been made in reducing TB incidence and mortality in Brazil, with the country meeting the Millennium Development Goals (MDGs) targets for TB control by 2015 [ 31 , 35 , 36 ]. This reduction can be explained by the progress in the access and quality of diagnostic and treatment services provided to patients with TB combined with improvements in the living conditions of the Brazilian population [ 37 ]. However, despite the general progress in the reduction of TB mortality and morbidity, the disease burden and its control still remain a challenge [ 6 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the general progress in the reduction of TB mortality and morbidity, the disease burden and its control still remain a challenge [ 6 , 31 ]. The progress is not homogeneous among states and municipalities, and is insufficient to reach the agreed global targets for End TB Strategy [ 37 ]. In this sense, compliance with the goals established by WHO and SDGs and agreed by the Brazilian Ministry of Health will be difficult to achieve without major and profound changes in the access, coverage, and quality of the health care provided, adherence to a social protection agenda, and changes in the regional economic and political context [30, 36].…”

Section: Discussionmentioning

confidence: 99%

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The burden of tuberculosis and attributable risk factors in Brazil, 1990–2017: results from the Global Burden of Disease Study 2017

Martins-Melo

Bezerra

Barbosa

et al. 2020

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Background Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). Methods This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). Results In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269–349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645–202,394), while 87,957 DALYs (95% UI: 50,624–146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex–age-specific TB burden was highest among males and in children under-1 year and the age groups 45–59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. Conclusions GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The burden of tuberculosis and attributable risk factors in Brazil, 1990–2017: results from the Global Burden of Disease Study 2017

Martins-Melo

Bezerra

Barbosa

et al. 2020

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“…A culture test can detect between 70% and 90% of cases; however, it requires at least 14 to 60 days to obtain a diagnosis. Because of this long period for obtaining a diagnosis, cultures are rarely used for making decisions regarding the treatment of a person with TB [23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and trend forecasting of tuberculosis diagnosis after the introduction of rapid molecular testing in a city in south-eastern Brazil

Berra¹,

Gomes²,

Acv³

et al. 2020

Preprint

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Background To evaluate the effectiveness of a rapid molecular test for the detection of tuberculosis and to predict the behaviour of the disease in a municipality of Brazil where tuberculosis is endemic. Methods An ecological study was carried out in Ribeirão Preto-SP on a population of tuberculosis cases notified between 2006 and 2017. Monthly tuberculosis incidence rates and the Average Monthly Percentage Change (AMPC) were calculated. In order to identify changes in the series, the breakpoint technique was performed; the rates were modelled and predictions of the incidence of tuberculosis until 2025 were made. Results AMPC showed a fall of 0.69% per month in tuberculosis and human immunodeficiency virus (TB-HIV) co-infection, a fall of 0.01% per month in general and lung tuberculosis and a fall of 0.33% per month in extrapulmonary tuberculosis. With the breakpoint technique, general and pulmonary tuberculosis changed in structure in late 2007, and extrapulmonary tuberculosis and TB-HIV co-infection changed in structure after 2014, which is considered as the cut-off point. The IMA(3) models were adjusted for general and pulmonary tuberculosis and TB-HIV co-infection, and the AR(5) models for extrapulmonary TB, and predictions were performed. Conclusions It is necessary that the algorithms for the care of a person with tuberculosis are followed and the diagnostic means used correctly in order to break the chain of transmission of tuberculosis and reduce its indexes.

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“…However, to our knowledge, no evidence exists for patients with HIV-associated TB, and especially in those more complicated cases requiring hospitalization. Such clinical trial play innovative and strategic role in WHO New Global Elimination Tuberculosis Strategy (Pillar III research strategy) [15].…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of N-acetylcysteine in hospitalized patients with HIV-associated tuberculosis: An open-label, randomized, phase II trial (RIPENACTB Study)

et al. 2020

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Despite the availability of effective antimicrobials, tuberculosis (TB) is still a serious health threat. Mortality is even higher in people living with HIV who are diagnosed with TB. New therapies are needed to shorten the time required to cure TB and decrease fatality rates in this population. N-acetylcysteine (NAC) is a glutathione precursor and has shown recently in experimental setting to present in vitro and in vivo anti-mycobacterial activity. We test the hypothesis that NAC is safe, well tolerated and secondarily efficacious as adjunctive anti-TB therapy in hospitalized individuals with HIV-associated TB. Patients were enrolled sequentially in a tertiary care center, in the Brazilian Amazon. We performed a randomized, parallel group, single-center, open study trial of two arms, in hospitalized patients over 18 years of age, with microbiologically confirmed pulmonary TB in HIV: one with rifampicin, isoniazid, pyrazinamide and ethambutol at standard doses (Control Group), and a second in which NAC 600 mg bid for eight weeks was added (NAC Group). A total of 21 and 18 patients were enrolled to the Control Group and NAC Group, respectively. Adverse event rates were similar in the two arms. Our findings suggest that in the more critical population of hospitalized patients with HIV-associated TB, the use of NAC was not unsafe, despite the low

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Tuberculosis: renewed challenge in Brazil

Cited by 22 publications

References 30 publications

The burden of tuberculosis and attributable risk factors in Brazil, 1990–2017: results from the Global Burden of Disease Study 2017

The burden of tuberculosis and attributable risk factors in Brazil, 1990–2017: results from the Global Burden of Disease Study 2017

Effectiveness and trend forecasting of tuberculosis diagnosis after the introduction of rapid molecular testing in a city in south-eastern Brazil

Safety and efficacy of N-acetylcysteine in hospitalized patients with HIV-associated tuberculosis: An open-label, randomized, phase II trial (RIPENACTB Study)

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