RESUMO
A tuberculose (TB) é considerada um grave problema de saúde pública. O hiato entre a disponibilidade de tecnologias diagnósticas e o êxito do tratamento questionam a suficiência da resposta dos serviços de saúde frente à doença. Objetivou-se identificar indicadores para o monitoramento e avaliação do controle da TB, por meio de revisão integrativa da literatura, realizada no SciELO, BIREME, SCOPUS e Embase, a partir da seleção dos termos: "programas e serviços de saúde"; "indicadores de avaliação utilizados nacional e internacionalmente"; e "controle da TB". Dos 110 estudos identificados, 24 foram elegíveis e permitiram a extração de 56 indicadores relacionados à estrutura (n=09) e processo (n=47). Os indicadores abordam a complexidade do controle da TB no país.
Tuberculosis (TB) is considered a serious public health problem. The gap between the availability of diagnostic technologies and the success of treatment questions the sufficiency of the health services' response to TB. This study aimed to identify indicators for monitoring and evaluating TB control. through an integrative literature review, carried out in SciELO, BIREME, SCOPUS and Embase, based on the selection of the terms: "health programs and services"; "assessment indicators used nationally and internationally"; and "TB control". Of the 110 studies identified, 24 were eligible and allowed the extraction of 56 indicators related to structure (n=09) and process (n=47). The indicators address the complexity of TB control in the country.
Assuntos
Atenção Primária à Saúde , Tuberculose , Avaliação em Saúde , Monitoramento Ambiental , Saúde Pública , Indicadores de Qualidade em Assistência à Saúde , Serviços de SaúdeRESUMO
OBJECTIVES: To identify scenarios based on socioeconomic, epidemiological and operational healthcare factors associated with tuberculosis incidence in Brazil. DESIGN: Ecological study. SETTINGS: The study was based on new patients with tuberculosis and epidemiological/operational variables of the disease from the Brazilian National Information System for Notifiable Diseases and the Mortality Information System. We also analysed socioeconomic and demographic variables. PARTICIPANTS: The units of analysis were the Brazilian municipalities, which in 2015 numbered 5570 but 5 were excluded due to the absence of socioeconomic information. PRIMARY OUTCOME: Tuberculosis incidence rate in 2015. DATA ANALYSIS: We evaluated as independent variables the socioeconomic (2010), epidemiological and operational healthcare indicators of tuberculosis (2014 or 2015) using negative binomial regression. Municipalities were clustered by the k-means method considering the variables identified in multiple regression models. RESULTS: We identified two clusters according to socioeconomic variables associated with the tuberculosis incidence rate (unemployment rate and household crowding): a higher socioeconomic scenario (n=3482 municipalities) with a mean tuberculosis incidence rate of 16.3/100 000 population and a lower socioeconomic scenario (2083 municipalities) with a mean tuberculosis incidence rate of 22.1/100 000 population. In a second stage of clusterisation, we defined four subgroups in each of the socioeconomic scenarios using epidemiological and operational variables such as tuberculosis mortality rate, AIDS case detection rate and proportion of vulnerable population among patients with tuberculosis. Some of the subscenarios identified were characterised by fragility in their information systems, while others were characterised by the concentration of tuberculosis cases in key populations. CONCLUSION: Clustering municipalities in scenarios allowed us to classify them according to the socioeconomic, epidemiological and operational variables associated with tuberculosis risk. This classification can support targeted evidence-based decisions such as monitoring data quality for improving the information system or establishing integrative social protective policies for key populations.