ABSTRACT
Objective:
to analyze the quality and management of care to tuberculosis/HIV coinfection in the state of São Paulo, Brazil.
Methods:
a descriptive study involving municipalities having at least five cases of tuberculosis/HIV coinfection in the Brazilian state of São Paulo notified in the tuberculosis notification system. To analyze the quality and management of care to tuberculosis/HIV coinfection, indicators were designed, based on tuberculosis evaluability assessment studies, and validated in Brazil. The municipalities were grouped according to their care quality and then submitted to multiple correspondence analysis.
Results:
the study formed a group with 18 municipalities (42.86%) with satisfactory care and management quality, and another group with 24 municipalities (57.14%) with a quality characterized as unsatisfactory. In the municipalities that showed a satisfactory result, the investigation identified a low proportion of tuberculosis/HIV coinfection, a low AIDS incidence rate, intermediate population size, and high coverage of the Community Health Workers’ Program and Family Health Strategy. The municipalities with unsatisfactory quality had a high proportion of tuberculosis/HIV coinfection and a high AIDS incidence rate.
Conclusion:
the study reveals the defining characteristics of quality and management of care to tuberculosis/HIV coinfection as chronic conditions, bringing relevant elements regarding the mobilization of resources and investments in the municipalities where these are necessary. Additionally, the investigation shows that health results are critical where care quality is unsatisfactory, pointing out the need for reorganizing care and the management of actions involving control of tuberculosis/HIV coinfection in these contexts.
DESCRIPTORS
Acquired immunodeficiency syndrome; Tuberculosis; Health services research; Operations research; Quality of health care; Health management.
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Caption: cure: Proportion of cure among the new TB cases coinfected by HIV; default: Proportion of treatment default among the new TB cases coinfected by HIV; death: Proportion of deaths among the new TB cases infected by HIV; nnotc: Proportion of new TB cases notified by the municipality where the TB patients lived; BK TBP: Proportion of new pulmonary TB cases coinfected by HIV that underwent sputum microscopy in the beginning of the treatment; conf bac: Proportion of new TB cases coinfected by HIV diagnosed with bacteriological confirmation; DOT ind: Proportion of directly observed treatment (DOT) indicated among the new TB cases coinfected by HIV; DOT exe: Proportion of DOT performed among the new TB cases coinfected by HIV with indication; con: Proportion of examined contacts among the identified contacts of the new TB cases coinfected by HIV. Observation: standardized values.
Caption: Size - I: Intermediate population size, L: Large population size; Region - I: Interior, C: Coast, G: Greater São Paulo area and capital; Priority - Y: priority municipality in TB control, N: nonpriority municipality in TB control; TB: TB incidence rate and its respective ranges (1-low, 2-intermediate, 3-high); AIDS: AIDS incidence rate and its respective ranges (1-low, 2-intermediate, 3-high); TB/HIV: Proportion of cases of TB/HIV coinfection and its respective ranges (1-low, 2-intermediate, 3-high); ESF: Coverage of Family Health Strategy and its respective ranges (1-low, 2-intermediate, 3-high); PACS: Coverage of the Community Health Agents Program and its respective ranges (1-low, 2-intermediate, 3-high).