RESUMO
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.
Assuntos
Antituberculosos/administração & dosagem , Terapia Diretamente Observada/métodos , Adesão à Medicação/estatística & dados numéricos , Tuberculose/tratamento farmacológico , Adulto , Antituberculosos/uso terapêutico , Brasil , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
SETTING: Tuberculosis (TB) is a major public health problem and an important cause of infectious disease-related death in young adults. TB rates are higher in vulnerable populations, including prisoners. OBJECTIVE: To describe the clinical and epidemiological characteristics associated with anti-tuberculosis treatment outcomes in the Brazilian prison population. DESIGN: The study population consisted of prisoners diagnosed with TB identified through the Sistema de Informação de Agravos de Notificação (Information System for Notifiable Diseases) between January 2007 and December 2011. Pearson's χ(2) test was used to compare the proportions and covariates associated with the outcome of interest. These variables were further analysed using the polytomous regression model. RESULTS: Compared to those who completed anti-tuberculosis treatment, prisoners who defaulted from treatment were younger (P < 0.001), less educated (P < 0.001) and more likely to be alcoholic (P < 0.001); they were more likely to have recurrent or relapse TB (P < 0.001) and they were not under directly observed treatment (P < 0.001). Those who died from TB tended to be older (P < 0.001) and alcoholic (P < 0.001); they were also more likely to have received treatment of unknown type (P < 0.001) and to have both pulmonary and extra-pulmonary TB (EPTB). Prisoners who developed multidrug-resistant TB were more likely to experience TB recurrence, return to treatment after default, change treatment centres and have EPTB. CONCLUSION: Our results highlight the need to improve TB control and policies in correctional facilities. Improving treatment outcomes of prisoners will also prevent transmission to other prisoners, their family members, and health professionals.