| 1. Management time |
The fact that there is a reasonable minimum period for recognizing the policy and the attributions inherent in planning and implementing actions in the territory |
More than 6 months and less than 1 year |
Interview |
| 1 year or more |
| 2. Recognizes the epidemiological profile of TB in the territory of operation |
Recognition of epidemiological, social, and clinical aspects, outcomes, and indicators related to reported TB cases |
Does not recognize |
Interview |
| Partially recognizes |
| Fully recognizes |
| 3. Preparation of annual action planning for TB control |
Existence of a periodic work plan, based on actions, goals, and financial incentives |
There is no work plan |
Interview and official documents: work plans, activity reports |
| There is a work plan |
| 4. Planning actions in accordance with the technical-operational guidelines and regulations established for PNCT in Brazil |
Use of guidance manuals and technical notes issued by the Brazilian Ministry of Health to draw up work plans, planning of goals, activities, and indicators to be implemented in the territories |
There is no work plan |
Interview and official documents: work plans, activity reports |
| There is a work plan, but it lacks coherence and correlation with the guidelines and regulations |
| There is a work plan prepared that is coherent and correlates with the PNCT guidelines and regulations |
| 5. Implementation of intersectorial planning of actions integrated with technical areas of related policies for the prevention and control of TB |
Workplan presents goals and joint actions with other areas and/or coordination of health policies (HIV/AIDS, women’s health, child health, men’s health, Indigenous health, among others) |
There is no work plan |
Interview and official documents: work plans, activity reports |
| There is a work plan, but it does not show the planning of goals and intersectorial actions |
| Work plan presents the planning of goals and actions of other related policy coordination in a timely and fragmented way |
| Work plan presents comprehensive integrated planning of goals and intersectorial actions |
| 6. Integrated planning of actions with the government and other institutions of civil society for actions to be carried out for vulnerable populations at risk of TB, including international migrants |
Work plan presenting actions and goals established with other federal, state, and municipal institutions, as well as nongovernmental institutions that work in the context of vulnerable populations (including international migrants), namely the government, unified system of social assistance, associations, and social organizations, among others |
There is no work plan |
Interview and official documents: work plans, activity reports |
| Work plan does not present planning of goals and actions established with other federal, state, and municipal institutions, as well as nongovernmental institutions that act directly with vulnerable populations |
| Work plan presents the planning of goals and actions established with other federal, state, and municipal institutions, as well as nongovernmental institutions that act directly with vulnerable populations |
| Work plan presents comprehensive integrated planning of goals and actions established with other federal, state, and municipal institutions, as well as nongovernmental institutions that act directly with vulnerable populations |
| 7. Planning and execution of financial budget for the provision of materials necessary for TB control actions |
Planned activities with defined financial budget to be carried out during the term of the work plan |
There is no defined budget plan |
Interview and official documents: work plans, activity reports |
| There is a defined budget plan, but there is no financial execution according to budget forecast |
| There is financial execution in accordance with the budget forecast |
| Management of epidemiological surveillance |
| 1. Provides SINAN for reporting and TB cases |
SINAN is implemented in all health units that provide care to patients with suspected TB, at all levels of care: primary, medium, and high complexity |
SINAN not implemented |
Interview |
| SINAN implemented but not available |
| SINAN implemented and available |
| 2. Recognizes, makes available, and supervises other information systems related to TB case reporting |
Information systems implemented by the Brazilian Ministry of Health where special situations related to TB are reported at all levels of care (individualized therapeutic regimens, resistant TB, pregnant women) |
Reporting systems for special cases of TB not implemented |
Interview |
| Systems for reporting special cases of TB implemented but not available |
| Special TB case notification systems implemented and available |
| 3. Periodically monitors and analyzes health indicators related to TB control |
Recognition and use of the main indicators related to TB prevention and control as a planning and monitoring tool, and analyzes them with bulletins and historical series |
Does not recognize the indicators and does not use them as a management tool |
Interview |
| Recognizes the indicators but does not use them as a management tool |
| Recognizes, uses, and analyzes indicators as a management tool |
| 4. Periodically carries out the quality analysis of the data entered in SINAN |
Periodic reviews the SINAN database to analyze and correct possible inconsistencies related to the notification and monitoring of TB cases until the case is closed |
Does not periodically review the database |
Interview and official documents: work plans, activity reports |
| Reviews database punctually and in fragments, not covering all the cases in the system |
| Reviews database periodically, covering all the cases in the system, until closure |
| 5. Manages and/or monitors cases in special treatments for TB |
Mapping and monitoring of cases of drug-resistant TB in children, pregnant women, and people with comorbidity, among other special situations |
Does not map and/or monitor cases in special treatment for TB |
Interview |
| Maps and monitors cases in special treatment for TB |
| 6. Recognizes territories and special populations most vulnerable and at risk of TB disease, including international migrants |
Identification and mapping of areas with higher incidence of the disease in the general population and in special populations, considered to be more vulnerable, including international migrants |
Does not map areas with higher incidence of TB in the general population and in special populations or areas at greater risk and vulnerability to TB |
Interview and official documents: work plans, activity reports |
| Maps areas with higher incidence of TB only for the general population, without considering special populations or areas at greater risk and vulnerability to TB |
| Maps areas with higher incidence of TB in the general population and in special populations or areas at greater risk and vulnerability to TB |
| 7. Maps and prioritizes areas with the highest incidence of cases for TB control actions |
Priority in planning and implementing actions in territories and areas with the highest number of new cases reported and under follow-up for clinical TB treatment |
There is no priority in planning and implementing actions in territories and areas with a higher number of new cases reported and under follow-up for clinical treatment of TB |
Interview and official documents: work plans, activity reports |
| There is a priority plan for implementing actions in territories and areas with the highest number of new cases reported and under follow-up for clinical treatment of TB |
| 8. Articulates, plans, and/or carries out cross-border TB surveillance actions |
Elaboration and/or intersectorial and inter-institutional plan of actions and goals that include epidemiological surveillance for TB prevention and control at the international and national borders of the territory |
There is no action plan for the prevention and control of TB at borders |
Interview and official documents: work plans, activity reports |
| There is an action plan prepared for the prevention and control of TB at borders, but it is not implemented |
| There is an action plan prepared for the prevention and control of TB at borders, and it is fully implemented |
| 9. Periodically issues epidemiological bulletins related to TB |
Preparation and dissemination of epidemiological bulletins that present data on new cases, outbreaks, epidemics, and results of health indicators related to TB in the territories |
Does not prepare bulletins |
Interview and official documents: work plans, activity reports |
| Prepares newsletters, but does not disclose them |
| Prepares bulletins, but discloses them in a punctual and restricted way, not covering access to all professionals involved in TB prevention and control |
| Prepares epidemiological bulletins regularly and widely |
| 10. Periodically issues management reports on the actions taken to control TB |
Preparation and dissemination of reports on the activities carried out, goals achieved, and results of indicators established for the prevention and control of TB in the territories |
Does not prepare reports |
Interview and official documents: work plans, activity reports |
| Prepares specific reports or only on request, but does not disclose activities carried out, goals achieved, and results of indicators established for the prevention and control of TB in the territories |
| Prepares and disseminates reports on the activities carried out, goals achieved, and results of indicators established for the prevention and control of TB in the territories |
| Management of the care network |
| 1. Promotes and supervises the notification of all confirmed cases of TB |
Periodic supervision to verify the implementation of TB cases notification in all health units at all levels of care in the territories of operation |
Does not carry out supervision |
Interview and official documents: work plans, activity reports |
| Carries out punctual supervision or only on request to verify the implementation of TB case notification in all health units at all levels of care, in the territories of operation |
| Periodically carries out supervision to verify the implementation of TB case notification in all health units at all levels of care, in the territories of operation |
| 2. Articulation with the reference laboratory network to provide TB diagnostic tests |
Preparation and execution of a joint action plan with the laboratory network to ensure the provision of diagnostic imaging tests and other diagnostic tests that are recommended by the PNCT technical regulations (sputum bacilloscopy, culture, X-ray, RMT, sensitivity test, HIV testing, TST, BCG vaccination) |
There is no action plan and no laboratory network offering laboratory tests for TB diagnosis |
Interview and official documents: work plans, activity reports |
| There is a plan of joint actions implemented and laboratory network offering tests for TB diagnosis |
| 3. Coordination and supervision of the active search for respiratory symptoms |
Supervision and implementation of actions to raise awareness among health professionals for active search for respiratory symptoms in the territories |
Not carried out |
Interview |
| Supervises and implements actions to raise awareness among health professionals about active search for respiratory symptoms in the territories, only on time or on demand |
| Periodically supervises and implements actions to raise awareness among health professionals about active search for respiratory symptoms in the territories |
| 4. Implementation of improvement and qualification actions on TB for professionals who work directly in the diagnosis and treatment of cases (FHS, outpatient clinics, hospitals) |
Promotion and implementation of qualification, updating, and/or professional improvement actions for all health professionals working in the clinical management of TB, at all levels of assistance |
Does not promote or carry out qualification, updating, and/or professional improvement actions for all health professionals who work in the clinical management of TB, at all levels of assistance |
Interview |
| Promotes or carries out qualification, updating, and/or professional improvement actions in a punctual and fragmented way, not covering all health professionals who work in the clinical management of TB, at all levels of assistance |
| Promotes or carries out qualification, updating, and/or professional improvement actions periodically and for all health professionals who work in the clinical management of TB, at all levels of assistance |
| 5. Encourages and fosters educational practices for the community on TB prevention and control |
Development and/or distribution of educational materials on TB prevention and control for health units at all levels of care |
Does not prepare or provide educational materials |
Interview and official documents: work plans, activity reports |
| Prepares and/or provides educational materials on TB prevention and control in a timely and fragmented way |
| Prepares and/or provides educational materials on TB prevention and control for health units of all levels of care |
| 6. Implementation and monitoring of DOT at all levels of care |
Elaborates an action plan and supervises the implementation of DOT in the territories |
There is no DOT implemented |
Interview and official documents: work plans, activity reports |
| There is an action plan designed to implement the DOT, but it is executed in a timely and fragmented manner |
| There is an action plan prepared for implementing the DOT and it is fully executed and periodically supervised |
| 7. Performs provision and logistical control of medicines and supplies necessary for the clinical management of TB in the territory of operation |
Planning, supervision, and control of the distribution of medicines and inputs used in the clinical management of TB with the logistics and distribution centers and pharmacies of health units at all levels of care |
Planning, supervision, and control of the distribution of medicines used in the clinical management of TB with logistics and distribution centers and pharmacies of health units at all levels of care |
Interview and official documents: work plans, activity reports |
| Planning, supervision, and control of the distribution of medicines used in the clinical management of TB with the logistics and distribution centers and pharmacies of health units at all levels of care |
| 8. Supervising and participating in the planning of bacteriological diagnosis and quality control actions at the reference laboratory |
Joint elaboration of measures for the implementation and supervision of quality control of samples and laboratory analyses carried out in the diagnostic reference laboratories for TB in the territories |
Does not supervise and participate in the planning of bacteriological diagnosis and quality control actions with the reference laboratory |
Interview |
| Supervises and participates in the planning of bacteriological diagnosis and quality control actions with the reference laboratory in a timely manner, on demand |
| Periodically supervises and participates in the planning of bacteriological diagnosis and quality control actions with the reference laboratory |
| 9. Implementation of a specific action plan for special populations or populations at greater risk and vulnerability for TB disease in each territory, including international migrants |
Elaboration and implementation of work plans that include specific health activities, goals, and indicators for special populations or those at greater risk and vulnerability for TB, based on the epidemiological profile of TB in the territories where it operates (including international immigrants), seeking to expand and facilitate access for these groups to the means of prevention, diagnosis, and treatment of TB |
There is no specific action plan for special populations or populations at greater risk and vulnerability to TB in each territory |
Interview and official documents: work plans, activity reports |
| There is a specific action plan for special populations or populations at greater risk and vulnerability to TB in each territory, but it is not implemented |
| There is a specific action plan for special populations or populations with higher risk and vulnerability to TB in each territory, but it is executed on time |
| There is a specific action plan for special populations or populations with greater risk and vulnerability to TB in each territory, and it is implemented in an integral manner |
| 10. Implementation of latent TB diagnosis in health units at all levels of care |
Provision of inputs and training for health professionals for the diagnosis and treatment of latent TB |
There is no implementation of actions for the diagnosis of latent TB in the territory |
Interview and official documents: work plans, activity reports |
| The implementation of actions for the diagnosis of latent TB is carried out in a punctual and fragmented way |
| The implementation of actions for the diagnosis of latent TB is carried out continuously and integrally |
| Management of expected/obtained results |
| 1. Compliance with the goals established in the annual planning |
Preparation and periodic issuance of a management report containing results related to goals, indicators, and planned activities |
There was no compliance with established goals |
Interview and data from official documents |
| Proportion of achievement of established goals was less than 60% of planned goals |
| Proportion of achievement of established goals was equal to or greater than 60% of the planned goals |
| 2. Execution of planned activities per quarter |
Periodic issuance of information on activities carried out for the prevention and control of TB in the territories |
Did not carry out the planned activities |
Interview and data from official documents |
| Partially carried out the planned activities |
| Carried out all planned activities |
| 3. Incidence coefficient of TB in the territory |
Estimation of the risk of TB (number of new TB cases, divided by population, multiplied by 100,000) |
10 cases per 100,000 inhabitants |
Data from SINAN and management reports and bulletins |
| Equal to 10 cases per 100,000 inhabitants |
| Less than 10 cases per 100,000 inhabitants |
| 4. TB mortality rate in the territory |
Estimating the risk of death from TB (number of deaths with underlying cause TB, divided by population, multiplied by 100,000) |
There was a reduction in the TB mortality rate |
Data from SINAN and management reports and bulletins |
| There was a maintenance of the TB mortality coefficient |
| There was an increase in the TB mortality rate |
| 5. Proportion cured after 6 months of treatment |
Measuring the success of TB treatment and the consequent decrease in disease transmission (total of new cases of pulmonary TB terminated with diagnosis of cure x 100/total of new cases of TB diagnosed) |
Less than 75 % of TB cases cured |
Data from SINAN and management reports and bulletins |
| At least 75% of TB cases cured |
| At least 85% of TB cases cured |
| More than 85% of TB cases cured |
| 6. Proportion of treatment abandonment |
Measurement of the proportion of patients who abandon treatment, remaining absent for more than 60 days after the last visit or remaining without medication for more than 30 days (total of TB cases terminated by treatment abandonment x 100/total of TB cases reported) |
Less than 5% of cases |
Data from SINAN and management reports and bulletins |
| Equal to 5% of cases |
| More than 5% of cases |
Thumbnail
Source: prepared by the authors.