Asunto(s)
Infecciones por VIH , Complicaciones Infecciosas del Embarazo , Tuberculosis , Humanos , Brasil/epidemiología , Femenino , Embarazo , Prevalencia , Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Tuberculosis/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Among Brazilian initiatives to scale up TB preventive therapy (TPT) are the adoption of the 3HP regimen (12 weekly doses of rifapentine and isoniazid [INH]) in 2021 and the implementation in 2018 of the TPT surveillance information system. Since then, 63% of the 76,000 eligible individuals notified completed TPT. Recommended regimens in this period were 6H, 9H (6 or 9 months of INH) and 4R (4 months of rifampicin).OBJECTIVE: To analyse the factors associated with TPT non-completion.METHODS: We analysed the cohort of TPT notifications from 2018 to 2020. Robust variance Poisson regression model was used to verify the association of TPT non-completion with sociodemographic, clinical and epidemiological variables.RESULTS: Of the 39,973 TPT notified in the study period, 8,534 (21.5%) were non-completed, of which 7,858 (92.1%) were lost to follow-up. Age 15-60 years (relative risk [RR] 1.27, 95% confidence interval [95% CI] 1.20-1.35), TPT with isoniazid (RR 1.40, 95% CI 1.19-1.64) and Black/mixed race (RR 1.17, 95% CI 1.09-1.25) were associated with a higher risk of non-completion.CONCLUSION: Individuals in situations of social and financial vulnerability such as being Black/pardo race, younger and on longer TPT regimens were more likely to be associated with TPT incompletion.
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Profilaxis Antibiótica , Antituberculosos , Isoniazida , Cumplimiento de la Medicación , Tuberculosis , Adolescente , Adulto , Humanos , Persona de Mediana Edad , Adulto Joven , Población Negra , Brasil/epidemiología , Isoniazida/uso terapéutico , Tuberculosis/prevención & control , Antituberculosos/uso terapéuticoRESUMEN
BACKGROUND: Tackling the social determinants of Tuberculosis (TB) through social protection is a key element of the post-2015 End TB Strategy. However, evidence informing policies are still scarce. Mathematical modelling has the potential to contribute to fill this knowledge gap, but existing models are inadequate. The S-PROTECT consortium aimed to develop an innovative mathematical modelling approach to better understand the role of social protection to improve TB care, prevention and control. METHODS: S-PROTECT used a three-steps approach: 1) the development of a conceptual framework; 2) the extraction from this framework of three high-priority mechanistic pathways amenable for modelling; 3) the development of a revised version of a standard TB transmission model able to capture the structure of these pathways. As a test case we used the Bolsa Familia Programme (BFP), the Brazilian conditional cash transfer scheme. RESULTS: Assessing one of these pathways, we estimated that BFP can reduce TB prevalence by 4% by improving households income and thus their nutritional status. When looking at the direct impact via malnutrition (not income mediated) the impact was 33%. This variation was due to limited data availability, uncertainties on data transformation and the pathway approach taken. These results are preliminary and only aim to serve as illustrative example of the methodological challenges encountered in this first modelling attempt, nonetheless they suggest the potential added value of integrating TB standard of care with social protection strategies. CONCLUSIONS: Results are to be confirmed with further analysis. However, by developing a generalizable modelling framework, S-PROTECT proved that the modelling of social protection is complex, but doable and allowed to draw the research road map for the future in this field.
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Modelos Teóricos , Política Pública , Tuberculosis/prevención & control , Brasil/epidemiología , Humanos , Renta , Estado Nutricional , Determinantes Sociales de la Salud , Tuberculosis/epidemiologíaRESUMEN
SETTING: All Brazilian states. OBJECTIVES: To assess the determinants of tuberculosis (TB) in patients undergoing directly observed therapy (DOT) and the impact of DOT on treatment outcomes. DESIGN: This is a cross-sectional study among TB patients aged ⩾18 years conducted in 2011. The primary outcome was the status of DOT received, while the secondary was the outcome of anti-tuberculosis treatment. RESULTS: In 2011, 35 775 (38.3%) subjects received DOT. The odds of receiving DOT were higher in patients with the following characteristics: brown/mestizo patients (OR 1.18, 95%CI 1.14-1.22) and those of other ethnic groups (OR 2.01, 95%CI 1.79-2.27) compared to Whites, alcohol users (OR 1.37, 95%CI 1.28-1.47) and those with mental disorders (OR 1.88, 95%CI 1.54-2.29). The odds of receiving DOT were lower in human immunodeficiency virus positive patients (OR 0.64, 95%CI 0.60-0.68). Patients who did not receive DOT were more likely to default from anti-tuberculosis treatment (OR 0.62, 95%CI 0.57-0.66), die due to TB (OR 0.68, 95%CI 0.61-0.77) and to have unknown treatment outcomes (OR 0.71, 95%CI 0.66-0.76). The adjusted preventable fraction of DOT in the reduction of unfavorable outcomes was 25%. CONCLUSION: Sociodemographic and clinical characteristics are determinants of anti-tuberculosis treatment outcomes in patients undergoing DOT; DOT use led to a 25% reduction in unfavorable outcomes.
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Antituberculosos/administración & dosificación , Terapia por Observación Directa/métodos , Cumplimiento de la Medicación/estadística & datos numéricos , Tuberculosis/tratamiento farmacológico , Adulto , Antituberculosos/uso terapéutico , Brasil , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To estimate the incremental cost-effectiveness of tuberculosis (TB) screening and isoniazid preventive therapy (IPT) among human immunodeficiency virus (HIV) infected adults in Rio de Janeiro, Brazil. DESIGN: We used decision analysis, populated by data from a cluster-randomized trial, to project the costs (in 2010 USD) and effectiveness (in disability-adjusted life years [DALYs] averted) of training health care workers to implement the tuberculin skin test (TST), followed by IPT for TST-positive patients with no evidence of active TB. This intervention was compared to a baseline of usual care. We used time horizons of 1 year for the intervention and 20 years for disease outcomes, with all future DALYs and medical costs discounted at 3% per year. RESULTS: Providing this intervention to 100 people would avert 1.14 discounted DALYs (1.57 undiscounted DALYs). The median estimated incremental cost-effectiveness ratio was $2273 (IQR $1779-$3135) per DALY averted, less than Brazil's 2010 per capita gross domestic product (GDP) of $11,700. Results were most sensitive to the cost of providing the training. CONCLUSION: Training health care workers to screen HIV-infected adults with TST and provide IPT to those with latent tuberculous infection can be considered cost-effective relative to the Brazilian GDP per capita.
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Antituberculosos/economía , Antituberculosos/uso terapéutico , Coinfección , Costos de los Medicamentos , Infecciones por VIH/economía , Isoniazida/economía , Isoniazida/uso terapéutico , Tuberculosis Latente/tratamiento farmacológico , Tuberculosis Latente/economía , Tamizaje Masivo/economía , Técnicos Medios en Salud/economía , Técnicos Medios en Salud/educación , Técnicas Bacteriológicas/economía , Brasil/epidemiología , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Evaluación de la Discapacidad , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Capacitación en Servicio/economía , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/epidemiología , Cadenas de Markov , Tamizaje Masivo/métodos , Modelos Económicos , Valor Predictivo de las Pruebas , Evaluación de Programas y Proyectos de Salud , Radiografía Torácica/economía , Factores de Tiempo , Resultado del Tratamiento , Prueba de Tuberculina/economíaRESUMEN
OBJECTIVES: To evaluate the population-based impact of a comprehensive intervention to strengthen tuberculosis (TB) control in Rocinha, the largest urban slum in Rio de Janeiro, Brazil. DESIGN: In July 2003, 40 lay persons were hired and trained as community health workers to supervise treatment, implement educational activities and establish a supportive social network for anti-tuberculosis treatment. Between July 2005 and June 2008, a door-to-door active case finding campaign was conducted. Data were obtained from the Brazilian National Reporting System, which collects information from the TB notification form for every reported case. RESULTS: Between January 2001 and December 2008, 2623 TB cases were reported, 852 before and 1771 after the start of the program. Following the intervention, treatment success rates increased (67.6% vs. 83.2%, P < 0.001) and default rates dropped (17.8% vs. 5.5%, P < 0.001). Compared to the pre-intervention period, the TB case rate declined by an average of 39 cases per 100,000 population per 6 months (P = 0.003) in the post-intervention period, although this may have been due to secular trends already in place at the start of the intervention. Case rates declined from 591/100,000 in 2001 to 496/100,000 in 2008. CONCLUSION: With proper planning and effective community involvement, a successful intervention can lead to high cure rates and may contribute to a decrease in TB notification rates.
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Antituberculosos/uso terapéutico , Servicios de Salud Comunitaria , Terapia por Observación Directa , Áreas de Pobreza , Tuberculosis/tratamiento farmacológico , Servicios Urbanos de Salud , Poblaciones Vulnerables , Adolescente , Adulto , Brasil/epidemiología , Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud , Notificación de Enfermedades , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Incidencia , Masculino , Objetivos Organizacionales , Educación del Paciente como Asunto , Evaluación de Programas y Proyectos de Salud , Apoyo Social , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/transmisión , Servicios Urbanos de Salud/organización & administración , Adulto JovenRESUMEN
BACKGROUND: Antiretroviral therapy (ART) significantly reduces tuberculosis (TB) incidence among persons with human immunodeficiency virus (HIV), but the safety and effectiveness of concomitant treatment for both diseases remain unclear. OBJECTIVE: To evaluate the impact of ART and anti-tuberculosis treatment on survival and risk of adverse events (AE) among co-infected individuals. METHODS: In a retrospective cohort study, clinical data were collected from 618 TB-HIV patients treated with rifampin, isoniazid and pyrazinamide ± ethambutol between 1 January 1995 and 31 December 2003. Patients were categorized into two groups: highly active ART (HAART) or no ART. Different HAART regimens were evaluated. Bivariate analysis, multivariate logistic regression and survival analysis using Cox proportional hazards regression were used. RESULTS: One-year mortality was lower for patients receiving HAART (adjusted hazard ratio [aHR] 0.17, 95%CI 0.09-0.31) compared to no ART. HAART increased the risk of AE (aHR 2.08, 95%CI 1.29-3.36). The odds of AE when receiving a ritonavir + saquinavir HAART regimen was eight-fold higher compared to no ART (OR 8.31, 95%CI 3.04-22.69), while efavirenz-based HAART was not associated with a significantly increased risk of AE (OR 1.42, 95%CI 0.76-2.65). CONCLUSION: HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment. Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.
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Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Coinfección/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Brasil/epidemiología , Coinfección/complicaciones , Coinfección/epidemiología , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiologíaRESUMEN
We measured quality of life (QOL) among individuals receiving treatment for human immunodeficiency virus (HIV; n = 45), active tuberculosis (TB; n = 44) and both TB and HIV (n = 9) in Rio de Janeiro, Brazil. Active treated TB was associated with lower physical health (absolute decrease of 0.95 standard deviation in summary score), but not mental health, among people being treated for HIV. Visual analogue scale scores were similar across all three populations, and corresponded closely to standard disability weights used in the literature. Among patients receiving treatment, those with HIV, active TB and both conditions together appear to have similar QOL.
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Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Coinfección , Infecciones por VIH/tratamiento farmacológico , Calidad de Vida , Tuberculosis/tratamiento farmacológico , Adulto , Análisis de Varianza , Brasil , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Encuestas de Atención de la Salud , Estado de Salud , Humanos , Modelos Lineales , Masculino , Salud Mental , Encuestas y Cuestionarios , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/psicología , Salud UrbanaRESUMEN
OBJECTIVE: To investigate spatial patterns of the incidence of pulmonary tuberculosis (TB) and its relationship with socio-economic status in Vitoria, Espirito Santo, Brazil. DESIGN: In a 4-year, retrospective, territory-based surveillance study of all new pulmonary TB cases conducted in Vitoria between 2002 and 2006, spatial patterns of disease incidence were compared using spatial clustering statistics (Anselin's local indicators of spatial association [LISA] and Getis-Ord Gi* statistics), smoothed empirical Bayes estimates and model-predicted incidence rates. Spatial Poisson models were fit to examine the relationship between socio-economic status and TB incidence. RESULTS: A total of 651 TB cases were reported across 78 neighborhoods, with rates ranging from 0 to 129 cases per 100,000 population. Moran's I indicated strong spatial autocorrelation among incidence rates (0.399, P < 0.0001), and four areas of high incidence were identified by LISA and Gi* statistics. Smoothed spatial empirical Bayes estimates demonstrate that two of these areas range from 70 to 90 cases/100,000, while the other two range from 40 to 70 cases/100,000. TB incidence and socio-economic status had a significant curvilinear relationship (P = 0.02). CONCLUSIONS: Data derived from these spatial statistical tools will help TB control programs to allocate TB resources to those populations most at risk of increasing TB rates and to target areas where TB control efforts need to be concentrated.
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Modelos Estadísticos , Tuberculosis Pulmonar/epidemiología , Teorema de Bayes , Brasil/epidemiología , Análisis por Conglomerados , Humanos , Incidencia , Distribución de Poisson , Estudios Retrospectivos , Factores SocioeconómicosRESUMEN
SETTING: Primary health clinics in Vitoria, Espirito Santo, Brazil. OBJECTIVE: To identify risk factors associated with patient and health care delays among patients seeking care at primary health clinics. METHODS: A prospective study among tuberculosis (TB) patients diagnosed in Vitoria between 1 January 2003 and 30 December 2007. A questionnaire ascertained the date of onset and duration of TB symptoms and medical records were reviewed. Between-group distributions of delay were compared and multivariate logistic regression was performed. RESULTS: Of 304 patients, 296 (97%) reported at least one TB symptom presenting for the first time to a qualified health service; 244 (80%) reported cough > 3 weeks. Median health care delay was 30 days (range 5-68), and median total delay was 110 days (range 26-784). Multivariate analysis revealed any cough (OR(adj) 7.35, 95%CI 2.40-22.5) and weight at TB diagnosis < 60 kg (OR(adj) 5.92, 95%CI 1.83-19.1) to be associated with patient delay of ≥ 30 days. Factors increasing risk of prolonged delay (≥ 90 days) were age ≥ 30 years (OR(adj) 1.93, 95%CI 1.09-3.43) and chest pain (OR(adj) 2.42, 95%CI 1.29-4.53). CONCLUSION: Improving health care workers' education regarding TB symptoms and implementing active case finding in targeted populations may reduce delays.
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Tos/diagnóstico , Diagnóstico Tardío/estadística & datos numéricos , Tuberculosis Pulmonar/diagnóstico , Adulto , Factores de Edad , Brasil/epidemiología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Tos/etiología , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Atención Primaria de Salud/estadística & datos numéricos , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Tuberculosis Pulmonar/epidemiologíaRESUMEN
SETTING: A large, impoverished squatters' settlement (favela), Rio de Janeiro, Brazil. OBJECTIVE: To assess the community impact of active case finding for tuberculosis (TB) compared to an enhanced case-finding strategy. DESIGN: A pair-matched, cluster-randomized trial comparing household symptom screening and spot sputum collection (Arm 1) vs. distribution of an educational pamphlet (Arm 2) was performed in a large Brazilian favela. We compared TB case-notification rates, time from symptom onset to treatment start and treatment completion proportions between arms. Fourteen neighborhoods (estimated population 58,587) were pair-matched by prior TB case rates and randomly allocated to one of two interventions. TB was diagnosed using acid-fast bacilli smears. New TB cases were interviewed and clinic records were reviewed. RESULTS: A total of 193 TB cases were identified in the 14 study neighborhoods (incidence proportion 329 per 100,000 population). The case identification rate in Arm 1 was 934/100,000 person-years (py) vs. 604/100,000 py in Arm 2 (RR 1.55, 95%CI 1.10-1.99). No significant differences were found in time from cough onset to treatment start or proportion completing treatment. CONCLUSIONS: A door-to-door case-finding campaign was more effective (while ongoing) at detecting prevalent cases and influencing people to come for care than leafleting, but no differences were seen in time to treatment start or treatment completion.
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Tamizaje Masivo/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Población Urbana , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Estudios Cruzados , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
SETTING: Central Rio de Janeiro, Brazil. OBJECTIVE: To compare the impact of routine DOTS vs. enhanced DOTS (DOTS-Ampliado or DOTS-A) on tuberculosis (TB) incidence. DESIGN: Cluster-randomized trial in eight urban neighborhoods pair-matched by TB incidence and randomly assigned to receive either the DOTS-A or DOTS strategy. DOTS-A added intensive screening of household contacts of active TB cases and provision of treatment to secondary cases and preventive therapy to contacts with latent TB infection (LTBI) to the standard DOTS strategy. The primary endpoint was the TB incidence rates in communities after 5 years of intervention. RESULTS: From November 2000 to December 2004, respectively 339 and 311 pulmonary TB cases were enrolled and 1003 and 960 household were identified in DOTS and DOTS-A communities. Among contacts from DOTS-A communities, 26 (4%) had active TB diagnosed and treated, 429 (61.3%) had LTBI detected and 258 (60.1%) started preventive therapy. TB incidence increased by 5% in DOTS communities and decreased by 10% in DOTS-A communities, for a difference of 15% after 5 years (P = 0.04). CONCLUSION: DOTS-A was associated with a modest reduction in TB incidence and may be an important strategy for reducing the burden of TB.
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Antituberculosos/administración & dosificación , Terapia por Observación Directa/métodos , Tuberculosis/prevención & control , Adulto , Antituberculosos/uso terapéutico , Brasil/epidemiología , Trazado de Contacto , Composición Familiar , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Tuberculosis/epidemiología , Población UrbanaRESUMEN
SETTING: Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN: A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.
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Instituciones de Atención Ambulatoria , Técnicas Bacteriológicas , Accesibilidad a los Servicios de Salud , Programas Nacionales de Salud , Satisfacción del Paciente , Atención Primaria de Salud , Tuberculosis/diagnóstico , Servicios Urbanos de Salud , Adulto , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Técnicas Bacteriológicas/estadística & datos numéricos , Brasil/epidemiología , Estudios Transversales , Femenino , Reforma de la Atención de Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Programas Nacionales de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Atención Primaria de Salud/estadística & datos numéricos , Tuberculosis/epidemiología , Tuberculosis/microbiología , Servicios Urbanos de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Treatment of latent tuberculosis (TB) infection (LTBI) in Brazil is recommended only in the case of contacts of pulmonary smear-positive TB patients aged
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Portador Sano/epidemiología , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/transmisión , Adolescente , Adulto , Antituberculosos/uso terapéutico , Brasil , Portador Sano/diagnóstico , Estudios de Cohortes , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Humanos , Incidencia , Isoniazida/uso terapéutico , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Pirazinamida/uso terapéutico , Estudios Retrospectivos , Rifampin/uso terapéutico , Riesgo , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto JovenRESUMEN
SETTING: Data from the mortality database, Rio de Janeiro City (RJC) Health Department, Rio de Janeiro, Brazil. OBJECTIVES: To determine the role played by tuberculosis (TB) in Brazil's human immunodeficiency virus (HIV) positive population, we investigated the frequency of TB as the primary cause of death among HIV-positive subjects in RJC. DESIGN: Information about acquired immune-deficiency syndrome (AIDS) deaths from 1996 to 2005 in individuals aged >12 years was obtained from the Mortality Information System (SIM), and the cause of death was classified according to the International Classification of Diseases (ICD-10), through primary causes coded in Chapter I--B20 to B24 (HIV disease). RESULTS: There were 8601 AIDS-related deaths in RJC between 1996 and 2005. TB was the primary cause of death in 9.0% of all AIDS-related deaths, while Pneumocystis carinii pneumonia (PCP) accounted for 4.7%. TB cases erroneously classified under other infectious diseases may have contributed to an underestimation of the number of TB deaths among HIV-positive patients. CONCLUSION: Our study showed that TB is the leading cause of AIDS-related deaths and is responsible for twice as many deaths as PCP, in a scenario of free access to antiretrovirals. The potential benefits of TB preventive treatment and of the availability of highly active antiretroviral treatment could not be established by this analysis.
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Síndrome de Inmunodeficiencia Adquirida/mortalidad , Tuberculosis/mortalidad , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adulto , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Causas de Muerte , Comorbilidad , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/mortalidad , Tuberculosis/epidemiologíaRESUMEN
SETTING: Out-patient primary health unit (OPHU) in Rio de Janeiro City, Brazil. OBJECTIVE: To evaluate the impact on the detection of tuberculosis (TB) cases of reducing the time of respiratory symptoms from 'cough > or = 3 weeks' to 'cough > or = 1 week' as a criteria for TB case finding among individuals visiting an OPHU for any other reason. DESIGN: Cross-sectional study. RESULTS: During the period of the study, 10.7% (765/ 7174) of subjects reported cough > or = 1 week. Among 542 subjects enrolled in the study with cough > or = 1 week, 15 (2.7%) cases were diagnosed with pulmonary tuberculosis (PTB, 2767/100000). The probability of detecting TB in the OPHU setting among subjects seeking care for respiratory symptoms was significantly higher than among those presenting to the OPHU for other reasons (OR 31.5, 95% CI 4.1-241.9; P < 0.0001). The probability of identifying TB among patients seeking care due to respiratory symptoms was not influenced by the duration of cough (P = 0.7). CONCLUSION: These findings suggest that the screening criteria for TB case finding of cough for less than the usual 3 weeks among patients who attend a health facility due to respiratory symptoms in settings with a high prevalence of TB may significantly improve the proportion of TB cases diagnosed.