Epidemiological profile of tuberculosis cases with HIV coinfection in Porto Alegre city, Brazil

Rossetto, Maíra; Brand, Évelin Maria; Hahn, Giselda Veronice; Oliveira, Dora Lúcia Leidens Corrêa de; Teixeira, Luciana Barcellos

doi:10.1590/0034-7167-2017-0613

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (5) • Sep-Oct 2019 • https://doi.org/10.1590/0034-7167-2017-0613 copy

Epidemiological profile of tuberculosis cases with HIV coinfection in Porto Alegre city, Brazil

Perfil epidemiológico de los casos de tuberculosis con coinfección VIH en Porto Alegre

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe and compare the epidemiological profile of cases of tuberculosis and HIV coinfection of the District Administration Health Units of Porto Alegre, Brazil, from 2009 to 2013.

Method:

Retrospective cohort with data from national health information systems. Sociodemographic, clinical and follow-up variables were investigated through association tests.

Results:

2,419 cases of tuberculosis and HIV coinfection were reported, with a mean age of 38 ± 9.91 years, predominantly white and with up to 7 years of study. The comparison between the District Administration Health Units was significant in terms of race/color (p<0.001), gender (p<0.001), schooling (p<0.004), age (p<0.003), place of origin (p<0.001), (p<0.001), alcoholism (p<0.001), indication and performance of Directly Observed Therapy (p<0.001), closure (p<0.001).

Conclusion:

Socioeconomic and treatment variables influence the occurrence of coinfection in different areas of Porto Alegre, reinforcing that the sum of different factors explains the indicators of the disease.

Descriptors:
Pulmonary Tuberculosis; Acquired Immunodeficiency Syndrome; Coinfection; Nursing; Public Health

Sociodemographic Characteristics	n (%)^* * Absolute and percentage number - (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form).
Administration Unit
Center	430 (17.8)
Northwest/Humaitá/Navegantes/Ilhas	159 (6.6)
North/Eixo Baltazar	264 (10.9)
East/Northeast	380 (15.7)
Glória/Cruzeiro/Cristal	286 (11.8)
South/Central South	170 (7)
Partenon/Lomba do Pinheiro	557 (23)
Sandbank/Extreme South	171 (7.1)
Race/color
White	1.357 (56.15)
Not White	1.054 (43.6)
Gender
Male	1.588 (65.6)
Female	831 (34.4)
Schooling
≤ 7 years	1.548 (64)
From 8 to 11 years	629 (26)
≥12 years or more	59 (2.4)

Clinical Characteristics	n (%)^* * Absolute and percentage number - (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form).
Type of Entry
New case	1.389 (57,4)
Relapse	351 (14,5)
Reentry after abandonment	622 (25,7)
Transference	57 (2,4)
Alcoholism
Yes	622 (25,7)
No	1.794 (74,2)
Diabetes
Yes	67 (2,8)
No	2.348 (97,1)
Mental disorder
Yes	99 (4,1)
No	2.314 (95,7)
TS Indication
Yes	627 (25,9)
No	1.785 (73,8)
Directly Observed Treatment performance
Yes	406 (16,8)
No	1.994 (82,4)
Type of Closure
Cure	858 (35,5)
Abandonment	861 (35,6)
Death	536 (22,1)
Transference	88 (3,6)
Multidrug-Resistant Tuberculosis	63 (2,6)

Characteristics	District Administration Units								p value
Characteristics	CEN	NHNI	NEB	EANO	GCC	SCS	PLP	SES	p value
Race/color									<0.001 ^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic.
White	271 (63%)	106 (66.7%)	166 (62.9%)	194 (51.3%)	172 (60.4%)	93 (55%)	276 (49.8%)	79 (46.5%)
Not White	159 (37%)	53 (33.3%)	98 (37.1%)	184 (48.7%)	113 (39.6%)	76 (45%)	278 (50.2%)	91 (53.5%)
Gender									<0.001 ^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic.
Female	117 (27.2%)	62 (39%)	86 (32.6%)	157 (41.3%)	110 (38.5%)	68 (40%)	162 (29.1%)	68 (39.8%)
Male	313 (72.8%)	97 (61%)	178 (67.4%)	223 (58.7%)	176 (61.5%)	102 (60%)	395 (70.9%)	103 (60.2%)
Schooling									0.004^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic.
Up to 7 years	262 (67%)	103 (68.2%)	162 (63.8%)	243 (69.4%)	195 (73.9%)	104 (65%)	360 (71.1%)	117 (73.1%)
From 8 to 11 years	106 (27.1%)	43 (28.5%)	89 (35%)	99 (28.3%)	66 (25%)	51 (32.3%)	135 (26.7%)	40 (25%)
Above 12 years	23 (5.9%)	5 (3.3%)	3 (1.2%)	8 (2.3%)	3 (1.1%)	3 (1.9%)	11 (2.2%)	3 (1.9%)
Age	38.36±10.03	37.29±9.32	38.91±10.80	37.55±9.71	36.24±9.40	39.69±10.87	37.70±9.50	39.69±9.85	0.003^ P value associated with the Kruskal-Wallis test. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administration: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI).
Total	430 (17.8%)	159 (6.6%)	264 (10.9%)	380 (15.7%)	286 (11.8%)	170 (7%)	557 (23%)	171 (7.1%)

Characteristics	District Administration Units								p value
Characteristics	CEN	NHNI	NEB	EANO	GCC	SCS	PLP	SES	p value
Type of entry									<0.001^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
New case	234 (54.4%)	105 (66%)	159 (60.2%)	199 (52.4%)	166 (58%)	114 (67.1%)	311 (55.8%)	101 (59.1%)
Relapse	56 (13%)	23 (14.5%)	36 (13.6%)	45 (11.8%)	29 (10.1%)	19 (11.2%)	110 (19.7%)	33 (19.3%)
Reentry	133 (30.9%)	25 (15.7%)	65 (24.6%)	130 (34.2%)	84 (29.4%)	33 (19.4%)	115 (20.6%)	36 (21.1%)
Transference	7 (1.6%)	6 (3.8%)	4 (1.5%)	6 (1.6%)	7 (2.4%)	4 (2.4%)	21 (3.8%)	1 (0.6%)
Alcoholism									<0.001^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
Yes	143 (33.3%)	30 (18.9%)	76 (28.8%)	110 (28.9%)	82 (28.8%)	44 (25.9%)	110 (19.8%)	27 (15.8%)
No	287 (66.7%)	129 (81.1%)	188 (71.2%)	270 (71.1%)	203 (71.2%)	126 (74.1%)	445 (80.2%)	144 (84.2%)
Diabetes									0.368^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
Yes	11 (2.6%)	6 (3.8%)	9 (3.4%)	14 (3.7%)	6 (2.1%)	5 (2.9%)	16 (2.9%)	0 (0%)
No	418 (97.4%)	153 (96.2%)	255 (96.6%)	366 (96.3%)	279 (97.9%)	165 (97.1%)	539 (97.1%)	171 (100%)
Mental disorder									0.325^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
Yes	19 (4.4%)	7 (4.4%)	9 (3.4%)	22 (5.8%)	9 (3.2%)	3 (1.8%)	26 (4.7%)	4 (2.3%)
No	419 (95.6%)	152 (95.5%)	255 (96.6%)	357 (94.2%)	275 (96.8%)	167 (98.2%)	528 (95.3%)	167 (97.7%)
Type of Closure									<0.001^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
Cure	126 (29.4%)	75 (47.5%)	117 (44.3%)	95 (25.3%)	79 (27.6%)	67 (39.4%)	229 (41.6%)	70 (41.2%)
Abandonment	185 (43.1%)	33 (20.9%)	79 (29.9%)	172 (45.7%)	117 (40.9%)	50 (29.4%)	169 (30.7%)	56 (32.9%)
Death	95 (22.1%)	44 (27.7%)	57 (21.6%)	86 (22.6%)	59 (20.6%)	40 (23.5%)	105 (18.8%)	42 (24.5%)
Transference	12 (2.8%)	3 (1.9%)	7 (2.7%)	9 (2.4%)	8 (2.8%)	7 (4.1%)	41 (7.4%)	0 (0%)
MDR-TB	11 (2.6%)	3 (1.9%)	4 (1.5%)	14 (3.7%)	16 (5.6%)	6 (3.5%)	7 (1.3%)	2 (1.2%)
Indicated DOT									<0.001^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
Yes	142 (33%)	26 (16.5 %)	53 (20.1%)	88 (23.2%)	84 (29.4%)	41 (24.4%)	155 (28%)	38 (22.2%)
No	288 (67%)	132 (83.5%)	211 (79.9%)	291 (76.8%)	202 (70.6%)	127 (75.6%)	399 (72%)	133 (77.8%)
DOT Performance									<0.001^* * P value associated with the homogeneity of proportions test based on Pearson's chi-square statistic. (Totals may differ due to the possibility of non-response of the subjects or the non-completion by the professional of some data in the tuberculosis notification form). Description of the District Administrations: Center (CEN), North/Eixo Baltazar (NEB), East/Northeast (EANO), Glória/Cruzeiro/Cristal (GCC), South/Central South (SCS), Partenon/Lomba do Pinheiro (PLP), Sandbank/Extreme South (SES), Northwest/Humaitá/Navegantes/Ilhas (NHNI). Multidrug-Resistant Tuberculosis-MDR-TB; Directly Observed Treatment-DOT.
Yes	111 (20.6%)	17 (10.8%)	26 (9.9%)	57 (15.2%)	40 (14%)	16 (9.5%)	112 (20.4%)	27 (15.8%)
No	316 (74%)	141 (89.2%)	237 (90.1%)	319 (84.8%)	245 (86%)	152 (90.5%)	438 (79.6%)	144 (84.2%)
Total	430 (17.8%)	159 (6.6%)	264 (10.9%)	380 (15.7%)	286 (11.8%)	170 (7%)	557 (23%)	171 (7.1%)

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[1] Corresponding Author:Maíra Rossetto E-mail: maira.rossetto@uffs.edu.br