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BACKGROUND: One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. METHODS: A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. RESULTS: We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). CONCLUSIONS: Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.

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OBJECTIVE: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. METHODS: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). RESULTS: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). CONCLUSIONS: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

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ABSTRACT Objective: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. Methods: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). Results: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). Conclusions: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

RESUMO Objetivo: Avaliar as implicações da proporção da renda familiar anual gasta nos períodos pré e pós-diagnóstico em pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose no Brasil. Métodos: Estudo transversal com pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose em cinco capitais brasileiras (uma em cada região do país). Resultados: Foram incluídos na análise 62 pacientes. O custo médio global da tuberculose foi de R$ 283,84 no período pré-diagnóstico e de R$ 4.161,86 no período pós-diagnóstico. Após os custos da doença tuberculosa, 71% dos pacientes ficaram desempregados, com um aumento global do desemprego; além disso, o número de pacientes não pobres diminuiu 5%, o número de pacientes pobres aumentou 6% e o número de pacientes extremamente pobres aumentou 5%. A maior proporção de renda familiar anual para cobrir os custos totais da tuberculose foi observada nos pacientes extremamente pobres (40,37% vs. 11,43% nos menos pobres). Conclusões: As políticas para mitigar os custos catastróficos devem incluir intervenções planejadas pelo sistema de saúde e medidas de proteção social para pacientes de baixa renda com tuberculose, a fim de eliminar a epidemia global de tuberculose até 2035, uma meta da OMS alinhada com os Objetivos de Desenvolvimento Sustentável propostos pela Organização das Nações Unidas.

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OBJECTIVE: To evaluate the impact of catastrophic costs on unfavorable tuberculosis treatment outcomes. METHODS: This was a prospective cohort study, conducted in five Brazilian state capitals (Manaus, Recife, Vitória, Campo Grande and Porto Alegre) from June 2016 to July 2018. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS: Of the 350 participants, 310 were included, of whom 30 presented unfavorable outcomes. Catastrophic cost (OR=2.53 -95% CI 1.13;5.67) and divorce (OR=5.29 -95% CI 1.39;20.05) increased the chances of unfavorable outcomes. CONCLUSION: Financial difficulties during tuberculosis treatment may impair its outcome. Catastrophic cost and divorce were determining factors for treatment outcomes.

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Objetivo: Avaliar o impacto dos custos catastróficos no desfecho desfavorável do tratamento da tuberculose. Métodos: Estudo de coorte prospectiva, realizado em cinco capitais de estados brasileiros (Manaus, Recife, Vitória, Campo Grande e Porto Alegre) no período de junho de 2016 a julho de 2018. Empregou-se regressão logística para calcular a razão de chances (odds ratio, OR) e os intervalos de confiança de 95% (IC95%). Resultados: Dos 350 participantes, 310 foram incluídos, dos quais 30 apresentaram desfecho desfavorável. Custo catastrófico (OR=2,53 - IC95% 1,13;5,67) e divórcio (OR=5,29 - IC95% 1,39;20,05) aumentaram as chances de desfecho desfavorável. Conclusão: Dificuldades financeiras durante o tratamento da tuberculose podem prejudicar seu desfecho. Os fatores determinantes para o desfecho do tratamento foram custo catastrófico e divórcio.

Objetivo: Evaluar el impacto de los costos catastróficos en el resultado desfavorable del tratamiento de la tuberculosis. Métodos: Estudio de cohorte prospectiva realizado en cinco capitales de estados brasileños (Manaus, Recife, Vitória, Campo Grande y Porto Alegre) entre junio de 2016 y julio de 2018. Se utilizó la regresión logística para calcular los odds ratios (OR) y los intervalos de confianza del 95% (IC95%). Resultados: De los 350 participantes, se incluyeron 310, y 30 tuvieron resultado desfavorable. El costo catastrófico (OR=2,53 - IC95% 1,13;5,67) y el divorcio (OR=5,29 - IC95% 1,39;20,05) aumentaron la obtención de un resultado desfavorable. Conclusión: Dificultades económicas enfrentadas durante el tratamiento de la tuberculosis pueden perjudicar el resultado del tratamiento. Las determinantes del tratamiento fueron el costo catastrófico y el divorcio.

Objective: To evaluate the impact of catastrophic costs on unfavorable tuberculosis treatment outcomes. Methods: This was a prospective cohort study, conducted in five Brazilian state capitals (Manaus, Recife, Vitória, Campo Grande and Porto Alegre) from June 2016 to July 2018. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (95%CI). Results: Of the 350 participants, 310 were included, of whom 30 presented unfavorable outcomes. Catastrophic cost (OR=2.53 -95% CI 1.13;5.67) and divorce (OR=5.29 -95% CI 1.39;20.05) increased the chances of unfavorable outcomes. Conclusion: Financial difficulties during tuberculosis treatment may impair its outcome. Catastrophic cost and divorce were determining factors for treatment outcomes.

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Resumo Objetivo avaliar o impacto econômico domiciliar do adoecimento pela tuberculose no Brasil. Método pesquisa transversal multicêntrica de 2016 a 2018, em cinco capitais do Brasil, em pacientes diagnosticados com tuberculose. Os custos totais foram a soma dos custos diretos e indiretos incorridos antes e durante o diagnóstico e tratamento. A regressão logística foi utilizada para estudar determinantes de custos catastróficos. A pobreza foi medida como renda familiar per capita diária < U$ 5,5. Resultados trezentos e sessenta e um pacientes foram inscritos no estudo. O custo extrapolação foi de R$3.664,47 (DP: R$ 2.667,67) e o custo total de extrapolação foi de R$22.291,82 (DP: R$ 16.259,50). No geral, 29% dos participantes do estudo foram caracterizados como pobres antes da tuberculose, e 39% depois. Em média, a renda diminuiu em 11% dos participantes e 41% tiveram custos catastróficos. Os determinantes estatisticamente significativos de experimentar custos catastróficos foram: participante ser o chefe da família, vivendo na pobreza antes da tuberculose, desemprego e interrupção do trabalho durante o tratamento (p < 0,05). Conclusão e implicações para a prática embora o tratamento seja financiado pelo governo, a tuberculose continua resultando em custos catastróficos e diminuição da renda para muitas famílias no Brasil.

Resumen Objetivo evaluar el impacto económico domiciliario de enfermarse por tuberculosis en Brasil. Método Investigación multicéntrica transversal de 2016 a 2018, en cinco capitales de Brasil, en pacientes diagnosticados con tuberculosis. Los costos totales fueron la suma de los costos directos e indirectos incurridos antes y durante el diagnóstico y el tratamiento. Se utilizó la regresión logística para estudiar los determinantes de los costos catastróficos. La pobreza se midió como un ingreso familiar diario per cápita < U$ 5,5. Resultados se inscribieron 361 pacientes en el estudio. El costo de extrapolación fue de R$ 3.664,47 (DE: R$ 2.667,67) y el costo total de extrapolación fue R$ 22.291,82 (DE: R$ 16.259,50). En general, el 29% de los participantes se caracterizaron como pobres antes de la tuberculosis y el 39%, después. En promedio, los ingresos disminuyeron en 11% de los participantes y el 41% tuvo costos catastróficos. Determinantes estadísticos de costos catastróficos: participante ser cabeza de familia; vivir en pobreza antes de la tuberculosis; desempleo; interrupción del trabajo durante el tratamiento (p<0.05). Conclusión e implicaciones para la práctica aunque el tratamiento es financiado por el gobierno, la tuberculosis sigue teniendo costos catastróficos y una disminución de los ingresos para muchas familias en Brasil.

Abstract Objective to assess the home economics impact of illness from Tuberculosis in Brazil. Method multicenter cross-sectional research from 2016 to 2018, in five capitals of Brazil, in patients diagnosed with tuberculosis. The total costs were the sum of the direct and indirect costs incurred before and during diagnosis and treatment. Logistic regression was used to study determinants of catastrophic costs. Poverty was measured as daily household income per capita < U$ 5.5. Results 361 patients were enrolled in the study. The extrapolation cost was R$ 3,664.47 (SD: R$ 2,667.67) and the total extrapolation cost was R$ 22,291.82 (SD: R$ 16,259.50). Overall, 29% of study participants were characterized as poor before tuberculosis, and 39% afterwards. On average, income declined by 11% among participants and 41% had catastrophic costs. The statistically significant determinants of experiencing catastrophic costs were: participant being the head of the family; living in poverty before tuberculosis; unemployment and interruption of work during treatment (p <0.05). Conclusion and implications for practice although treatment is financed by the government, tuberculosis continues to cause catastrophic costs and decreased of income for many families in Brazil.

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Introduction: Tuberculosis is historically associated with poverty, generating costs that can influence treatment. Considering the impact of the costs of illness, the importance of adapting the instrument is highlighted. Objective: To adapt transculturally to Brazilian Portuguese the instrument Tool to Estimate Patient's Costs. Methods: Study of the type transcultural adaptation of instrument. The translation followed the criteria described by Herdman, 1998, in order to preserve functional equivalence as much as possible. The questionnaire with cross-cultural adaptation was applied to 77 patients, with at least one full month of treatment for the disease. Results: Instrument was shown with Cronbach Alpha above 0.71 constituting a good tool for measuring the costs of the disease, being necessary modifications. Conclusions: This study suggests the creation of an instrument adapted for the treatment of TB in Brazil, for the evaluation of costs with the illness by tuberculosis.

Introducción: La tuberculosis está históricamente asociada con la pobreza, generando costes que pueden influir en el tratamiento. Considerando el impacto de estas cuantías de la enfermedad, se destaca la importancia de la adaptación del instrumento. Objetivo: Adaptar transculturalmente al portugués brasileño la herramienta "Tool to Estimate Patient's Costs". Métodos: Estudio del tipo adaptación transcultural del instrumento. La traducción siguió los criterios descritos por Herdman (1998), para preservar al máximo la equivalencia funcional. El cuestionario, con adaptación transcultural, fue aplicado en 77 pacientes, con al menos un mes completo de tratamiento para la enfermedad. Resultados: El instrumento presentó resultado de 0,71 con el alfa de Cronbach, constituyéndose en una buena herramienta para medir los costes de la enfermedad, siendo necesarias modificaciones. Conclusiones: Este estudio sugiere la creación de un instrumento adaptado para el tratamiento de la TB en Brasil, para la evaluación de los costes con la enfermedad por tuberculosis.

Introdução: A tuberculose é historicamente associada à pobreza, gerando despesas que podem influenciar no tratamento. Considerando o impacto dos custos do adoecimento, destaca-se a importância da adaptação do instrumento. Objetivo: Adaptar transculturalmente para o português brasileiro o instrumento "Tool to Estimate Patient's Costs". Métodos: Estudo do tipo adaptação transcultural de instrumento. A tradução seguiu os critérios descritos por Herdman (1998), de forma a preservar ao máximo a equivalência funcional. O questionário, com adaptação transcultural, foi aplicado em 77 pacientes, com pelo menos um mês completo de tratamento para a doença. Resultados: Instrumento mostrou-se com alfa de Cronbach acima de 0,71, constituindo-se em uma boa ferramenta para mensuração dos custos da doença, sendo necessárias modificações. Conclusões: Este estudo sugere a criação de um instrumento adaptado para o tratamento da TB no Brasil, para avaliação dos custos com o adoecimento por tuberculose.

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Comparar, quanto aos aspectos clínicos, radiológicos e epidemiológicos, todos os casos de tuberculose (TB) diagnosticados nos serviços terciários de atenção à saúde com aqueles diagnosticados no nível primário de atenção à saúde do município de Vitória-ES. Métodos:Estudo de corte transversal, retrospectivo, com análises do banco de dados do SINAN, para identificar todos os casos residentes no município de Vitória-ES e diagnosticados com tuberculose nos anos de 2006 e 2007. Os pacientes foram divididos em dois grupos: os diagnosticados na Atenção Primária à Saúde (APS) e os diagnosticados na Atenção Terciáriaà Saúde (ATS). Para análise estatística, utilizou-se o programa Stata Corp 9.0.Resultados: Identificou-se um total de 338 pacientes; destes, 207 (61,24%) diagnosticados na APS e 131 (38,76%) na ATS. Observou-se um predomínio da forma clínica pulmonar em ambosos grupos, todavia, a extrapulmonar apresentou maior frequência no grupo da ATS. Quando analisados os resultados da baciloscopia de escarro, a positividade foi encontrada em 114(55,07%) dos pacientes da APS e em 57 (43,51%) da ATS. Com relação à positividade da cultura, 119 (57,48%) pacientes diagnosticados na APS e apenas 38 (29%) na ATS tiveram resultado positivo. Conclusão: Háevidência de elevada proporção de pacientes com TB notificados como “casos novos” na Atenção Terciária no município e foi notado um predomínio da forma clínica pulmonar em ambos os grupos – APS e ATS. Todavia, aextrapulmonar apresentou maior frequência neste...

To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB) diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitória-ES. Methods:Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitória-ES and diagnosed with TB in 2006 and 2007.Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC) and those diagnosed in Tertiary Health Care (THC). For statistical analysis, it was used the software STATA CORP 9.0. Results:338 patients were identified; 207 (61.24%) of these were diagnosed in PHC and 131 (38.76%) in THC. The pulmonary form was predominantin both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07%) patients of the PHC and in 57 (43.51%) of THC. Regarding the positive cultures, 119 (57.48%) patients diagnosed in PHC and only 38 (29%) in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” inTHC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter...

Comparar todos los casos de tuberculosis (TB) diagnosticados en los servicios terciarios de salud con aquellosdiagnosticados en nivel primario de salud del municipio de Vitoria-ES acerca de los aspectos clínicos, radiológicos yepidemiológicos Métodos: Estudio trasversal, retrospectivo, con análisis del banco de datos del SINAN para identificar todos los casos residentes en el municipio de Vitoria-ES y diagnosticados con tuberculosis en los años 206 y 2007. Los pacientes fuerondivididos en dos grupos: los diagnosticados en la Atención Primaria en Salud (APS) y los diagnosticados en la Atención Terciaria en Salud (ATS). Para el análisis estadístico se utilizó el programa Stata Corp 9.0. Resultados:Se identificó un total de 338 pacientes; de esos, 207 (61,24%) fueron diagnosticados en la APS y 131 (38,76%) en la ATS. Se observó un predominio de la forma clínica pulmonar en ambos grupos, sin embargo, laextra pulmonar presentó mayor frecuencia en el grupo de la ATS.Cuando analizados los resultados de la baciloscopia de esputo, la positividad fue encontrada en 114 (55,07%) de los pacientes de la APS y en 57 (43,51%) de la ATS. Respecto la positividadde la cultura, 119 (57,48%) pacientes diagnosticados en la APS y apenas 38 (29%) en la ATS tuvieron resultado positivo. Conclusión: Hay evidencia de elevada proporción de pacientescon TB notificados como “casos nuevos” en la Atención Terciaria del municipio y fue observado un predominio de la forma clínica pulmonar en ambos grupos – APS y ATS. Sin embargo, la extrapulmonar presentó mayor frecuencia en este...

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The objective of this study was to compare the costs and outcomes associated with guardian-supervised directly observed treatment relative to the standard of care Directly Observed Therapy, Short Course (DOTS) provided by community health workers (CHW). New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients' families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient. 130 patients were included in the study; 84 chose CHW-supervised DOTS and 46 chose guardian-supervised DOTS. 45 of 46 (98%) patients treated with guardian-supervised DOTS were cured or completed treatment compared to 70/84 (83%) of the CHW-supervised patients (p = 0.01). Logistic regression showed only the strategy of supervision to be a significant association with treatment outcome, with guardian-supervised care strongly protective. Cost per patient treated with guardian-supervised DOTS was US$398, compared to US$548 for CHW-supervised DOTS. The guardian-supervised DOTS is an attractive option to complement CHW-supervised DOTS.

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The objective of this study was to compare the costs and outcomes associated with guardian-supervised directly observed treatment relative to the standard of care Directly Observed Therapy, Short Course (DOTS) provided by community health workers (CHW). New cases of culture-positive pulmonary tuberculosis (TB) treated in Vitória, Espírito Santo State, Brazil, between January 2005 and December 2006 were interviewed and chose their preferred treatment strategy. Costs incurred by providers and patients (and patients' families) were estimated, and cost-effectiveness was assessed by comparing costs per successfully treated patient. 130 patients were included in the study; 84 chose CHW-supervised DOTS and 46 chose guardian-supervised DOTS. 45 of 46 (98 percent) patients treated with guardian-supervised DOTS were cured or completed treatment compared to 70/84 (83 percent) of the CHW-supervised patients (p = 0.01). Logistic regression showed only the strategy of supervision to be a significant association with treatment outcome, with guardian-supervised care strongly protective. Cost per patient treated with guardian-supervised DOTS was US$398, compared to US$548 for CHW-supervised DOTS. The guardian-supervised DOTS is an attractive option to complement CHW-supervised DOTS.

Comparar os custos e os resultados associados ao tratamento de tuberculose (TB) supervisionado por domiciliares quanto ao realizado pelos agentes comunitários de saúde (ACS). Participaram do estudo todos os casos de TB pulmonar com cultura positiva tratada na cidade de Vitória, Espírito Santo, Brasil, entre janeiro de 2005 e dezembro de 2006. Os pacientes escolheram a estratégia de tratamento preferencial. Os custos incorridos pelos prestadores e os doentes foram estimados, e relação custo-efetividade foi avaliada comparando os custos por doente tratado com sucesso. Um total de 130 pacientes foi incluído no estudo, 84 escolheram ACS e 46 escolheram tratamento supervisionado por domiciliares. 45 de 46 (98 por cento) dos doentes tratados com supervisionamento por domiciliares foram curados ou tratamento completado em comparação com 70/84 (83 por cento) dos pacientes ACS (p = 0,01). Regressão logística mostrou o tratamento supervisionado por domiciliares significativamente protetor em relação ao abandono do tratamento da TB ao realizado pelo ACS. Custo por paciente tratado com o tratamento supervisionado por domiciliares foi de US$ 398, em comparação com US$ 548 para ACS. Tratamento supervisionado por domiciliares é uma opção mais custo-efetividade do que a supervisão pelo ACS.

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OBJECTIVE: To determine the principal adverse effects of the tuberculosis treatment regimen recommended by the Brazilian Ministry of Health. METHODS: A prospective descriptive study involving 79 tuberculosis patients treated at the Clinical Research Center of the Cassiano Antonio Moraes University Hospital, in the city of Vitória, Brazil, between 2003 and 2006. The treatment regimen consisted of isoniazid, rifampicin, pyrazinamide and ethambutol for four months, followed by rifampicin and isoniazid for two months. During the treatment period, the patients were clinically evaluated every week and had a monthly medical visit. RESULTS: The overall incidence of adverse effects was 83.54%. Articular/bone/muscle involvement was the most common, followed by skin involvement (24.94% and 22.09%, respectively). Adverse effects were more common in the second month of treatment (41.59%). Modification of the treatment regimen was unnecessary. One patient required concomitant medication to counter the adverse effects. The cure rate was 100%. CONCLUSIONS: The overall incidence of adverse effects related to the new treatment regimen recommended by the Brazilian Ministry of Health was high. However, none of those effects demanded a change in the regimen, which was effective in the patients evaluated.

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Objetivo: Comparar os resultados de cura por tuberculose entre pacientes supervisionados pelo membro familiar e pelo profissional de saúde. Métodos: Estudo de coorte prospectiva de 171 pacientes de Vitória, ES, no período de 2004 a 2007. Cada paciente foi acompanhado por seis meses até a finalização do tratamento. Dos pacientes estudados, 59 pacientes tratados eram supervisionados por um membro familiar e 112 pelos profissionais de saúde. Foram avaliados dados sociodemográficos e clínicos dos pacientes. Diferenças entre os grupos de estudo foram avaliadas utilizando o teste qui-quadrado ou teste t de Student ao nivel de significância de 5 por cento. Resultados: A maioria dos sujeitos do estudo apresentaram bacioscopia positiva e cultura confirmada para tuberculose. Dois pacientes tinham sorologia positiva para HIV. Um número maior de pacientes no grupo supervisionado por profissionais de saúde não eram alfabetizados, comparado com aqueles pacientes do grupo supervisionado por membros familiares (p = 0,01). Todos os pacientes supervisionados por um familiar foram...(AU)Objetivo: Comparar los resultados de cura por tuberculosis entre pacientes supervisados por ele miembro familiar y por el profesional de salud. Métodos: Estudio de cohorte prospectivo de 171 pacientes de Vitória, sureste de Brasil, en el período de 2004 a 2007. Cada paciente fue acompañado por seis meses hasta la finalización del tratamiento. De los pacientes estudiados, 59 pacientes tratados eran supervisados por un miembro familiar y 112 por los profesionales de salud. Fueron evaluados datos sociodemográficos y clínicos de los pacientes. Diferencias entre los grupos de estudio fueron evaluadas utilizando la prueba Chi-cuadrado o prueba t de Student al nivel de significancia de 5 por ciento. Resultados: La mayoría de los sujetos de estudio presentaron bacioscopia positiva y cultivo confirmado...

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OBJETIVO: Determinar os principais efeitos adversos causados pelo esquema de tratamento da tuberculose preconizado pelo Ministério da Saúde. MÉTODOS: Estudo descritivo e prospectivo envolvendo 79 pacientes com tuberculose tratados no Centro de Pesquisa Clínica do Hospital Universitário Cassiano Antônio Moraes, no município de Vitória, ES, entre 2003 e 2006. O regime de tratamento consistiu em isoniazida, rifampicina, pirazinamida e etambutol por quatro meses, seguido de rifampicina e isoniazida por dois meses. Durante o tratamento, os pacientes foram clinicamente avaliados todas as semanas e tinham uma visita médica mensal. RESULTADOS: A incidência geral de efeitos adversos foi de 83,54 por cento. O envolvimento articular/ósseo/muscular e o envolvimento cutâneo foram mais frequentes (24,94 por cento e 22,09 por cento, respectivamente). Os eventos adversos foram mais comuns no segundo mês de tratamento (41,59 por cento). Não houve necessidade de modificação do esquema de tratamento. Apenas 1 paciente necessitou de medicação para amenizar os efeitos adversos. A taxa de cura foi de 100 por cento. CONCLUSÕES: Apesar de alta, a incidência de efeitos adversos com o novo esquema de tratamento preconizado pelo Ministério da Saúde não exigiu a modificação do esquema de tratamento, que foi eficaz.

OBJECTIVE: To determine the principal adverse effects of the tuberculosis treatment regimen recommended by the Brazilian Ministry of Health. METHODS: A prospective descriptive study involving 79 tuberculosis patients treated at the Clinical Research Center of the Cassiano Antonio Moraes University Hospital, in the city of Vitória, Brazil, between 2003 and 2006. The treatment regimen consisted of isoniazid, rifampicin, pyrazinamide and ethambutol for four months, followed by rifampicin and isoniazid for two months. During the treatment period, the patients were clinically evaluated every week and had a monthly medical visit. RESULTS: The overall incidence of adverse effects was 83.54 percent. Articular/bone/muscle involvement was the most common, followed by skin involvement (24.94 percent and 22.09 percent, respectively). Adverse effects were more common in the second month of treatment (41.59 percent). Modification of the treatment regimen was unnecessary. One patient required concomitant medication to counter the adverse effects. The cure rate was 100 percent. CONCLUSIONS: The overall incidence of adverse effects related to the new treatment regimen recommended by the Brazilian Ministry of Health was high. However, none of those effects demanded a change in the regimen, which was effective in the patients evaluated.

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OBJECTIVE: To compare tuberculosis cure rates among patients supervised by household members or health care workers. METHODS: Prospective cohort study of 171 patients treated by the program in Vitoria, Southeastern Brazil, from 2004 to 2007. Each patient was followed-up for six months until the end of the treatment. Of the patients studied, a household member supervised 59 patients and healthcare workers supervised 112 patients. Patients' sociodemographic and clinic data were analyzed. Differences between groups were assessed using chi-square test or Student's t-test. Significance level was set at 5%. RESULTS: Most patients had smear positive, culture confirmed pulmonary tuberculosis. Two patients were HIV-positive. There were more illiterate patients in the healthcare-supervised group, in comparison to those supervised by their families (p=0.01). All patients supervised by a household member were cured compared to 90% of the patients supervised by health care workers (p = 0.024). CONCLUSIONS: Successful tuberculosis treatment was more frequent when supervised by household members.

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OBJECTIVE: To describe the factors associated with nonadherence to TB chemoprophylaxis in patients older than 15 years of age treated via referral TB control programs. METHODS: A historical cohort study was carried out based on medical charts related to cases treated via referral TB control programs in the city of Vitória, Brazil, between 2002 and 2007. Cases of infection with Mycobacterium tuberculosis were stratified into two groups: health care workers (HCW group); and individuals who were not health care workers (NHCW group). RESULTS: A total of 395 patients were included in the study: 35 in the HCW group and 360 in the NHCW group. The mean age in the HCW and NHCW groups was 34.8 and 32.4 years, respectively (p = 0.36). Of the 35 patients in the HCW group, 29 (82.9%) were female, compared with 180 (50.0%) of the 360 patients in the NHCW group. In the HCW and NHCW groups, respectively, 15 (42.9%) and 169 (46.9%) of the patients were contacts of TB cases. In addition, 9 (25.7%) and 157 (78.5%) the HCW and NHCW group patients, respectively, were HIV-infected. Nonadherence to chemoprophylaxis was 37.1% and 21.9% in the HCW and NHCW groups, respectively (p = 0.045). In the multivariate analysis, the factors associated with nonadherence were being a health care worker (OR = 8.60; 95% CI: 2.09-35.41), being HIV-infected (OR = 4.57; 95% CI: 1.2-17.5) and having had contact with a TB patient (OR = 2.65; 95% CI: 1.15-6.12). CONCLUSIONS: In order to improve adherence to TB chemoprophylaxis, new TB control program strategies are needed, especially for health care workers and HIV-infected patients.

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OBJETIVO: Descrever os fatores associados ao abandono de quimioprofilaxia de TB em maiores de 15 anos atendidos em programas de referência de controle da doença. MÉTODOS: Realizou-se um estudo de coorte histórica com análise de prontuários preenchidos entre 2002 e 2007 nos programas de referência de controle da doença no município de Vitória (ES). Os casos de infecção por Mycobacterium tuberculosis foram estratificados em dois grupos- profissionais de saúde (grupo PS) e indivíduos não profissionais de saúde (grupo NPS). RESULTADOS: Um total de 395 indivíduos foi incluído no estudo: 35 no grupo PS e 360 no grupo NPS. A média de idade nos grupos PS e NPS foi de 34,8 e 32,4 anos, respectivamente (p = 0,36). A maioria de pacientes no grupo PS eram mulheres (29; 82,9 por cento), enquanto 180 pacientes no grupo NPS eram mulheres (50,0 por cento). Nos grupos PS e NPS, 15 e 169 pacientes (42,9 por cento vs.46,9 por cento), respectivamente, tiveram contatos de pacientes com TB, e 9 e 157 (25,7 por cento vs. 78,5 por cento) eram portadores de HIV, respectivamente. O abandono da quimioprofilaxia foi de 37,1 por cento e 21,9 por cento nos grupos PS e NPS, respectivamente (p = 0,042). Na análise multivariada, os fatores associados ao abandono da quimioprofilaxia foram ser profissional de saúde (OR = 8,60; IC95 por cento: 2,09-35,41), indivíduos HIV positivos (OR = 4,57; IC95 por cento: 1,2-17,5), ser contato de paciente com TB (OR = 2,65; IC95 por cento: 1,15-6,12). CONCLUSÕES: Os programas de controle de TB necessitam de novas estratégias em relação à adesão à quimioprofilaxia, principalmente para os profissionais de saúde e pacientes HIV positivos.

OBJECTIVE: To describe the factors associated with nonadherence to TB chemoprophylaxis in patients older than 15 years of age treated via referral TB control programs. METHODS: A historical cohort study was carried out based on medical charts related to cases treated via referral TB control programs in the city of Vitória, Brazil, between 2002 and 2007. Cases of infection with Mycobacterium tuberculosis were stratified into two groups: health care workers (HCW group); and individuals who were not health care workers (NHCW group). RESULTS: A total of 395 patients were included in the study: 35 in the HCW group and 360 in the NHCW group. The mean age in the HCW and NHCW groups was 34.8 and 32.4 years, respectively (p = 0.36). Of the 35 patients in the HCW group, 29 (82.9 percent) were female, compared with 180 (50.0 percent) of the 360 patients in the NHCW group. In the HCW and NHCW groups, respectively, 15 (42.9 percent) and 169 (46.9 percent) of the patients were contacts of TB cases. In addition, 9 (25.7 percent) and 157 (78.5 percent) the HCW and NHCW group patients, respectively, were HIV-infected. Nonadherence to chemoprophylaxis was 37.1 percent and 21.9 percent in the HCW and NHCW groups, respectively (p = 0.045). In the multivariate analysis, the factors associated with nonadherence were being a health care worker (OR = 8.60; 95 percent CI: 2.09-35.41), being HIV-infected (OR = 4.57; 95 percent CI: 1.2-17.5) and having had contact with a TB patient (OR = 2.65; 95 percent CI: 1.15-6.12). CONCLUSIONS: In order to improve adherence to TB chemoprophylaxis, new TB control program strategies are needed, especially for health care workers and HIV-infected patients.

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A tuberculose acomete 8 milhões de pessoas anualmente em todo o mundo. A população de asilos convive com situações de fragilidade social, favorecendo a transmissão da doença. O objetivo deste trabalho foi traçar o perfil epidemiológico de casos notificados de tuberculose entre de moradores de abrigos em Vitória e Vila Velha no período de2000 a 2006. No período foram notificados 32 casos, 23 residentes de Vitória, 9 em Vila Velha, com idade média de 41 anos, sendo 30 do sexo masculino. A forma pulmonar foi predominante (88%), 91% dos casos apresentaram raios-X suspeito e 97% não realizaram o teste tuberculínico. O tratamento supervisionado ocorreu em50% dos pacientes. 50% dos pacientes obtiveram cura, 18,8% abandonaram o tratamento, 15,6% morreram e 15,6% foram transferidos. Apesar das dificuldades de controlar a tuberculose no interior de abrigos, realizar um rastreamento dessa população seria indicado para evitar a disseminação da doença.