TB-HIV co-infection: spatial and temporal distribution in the largest Brazilian metropolis

Cavalin, Roberta Figueiredo; Pellini, Alessandra Cristina Guedes; Lemos, Regina Rocha Gomes de; Sato, Ana Paula Sayuri

doi:10.11606/s1518-8787.2020054002108

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Sumário

Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002108 copy

TB-HIV co-infection: spatial and temporal distribution in the largest Brazilian metropolis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To describe the spatial and temporal distribution of TB-HIV co-infection, as well as the profile of the characteristics of the co-infected population in the municipality of São Paulo.

METHODS

This is an ecological and time series study with data from the Tuberculosis Patient Control System (TBWeb), including all new cases of tuberculosis co-infected individuals with HIV living in the municipality from 2007 to 2015. Time trends of the disease were analyzed using Prais-Winsten regression. The cases were geocoded by the address of residence for the elaboration of maps with the incidence rates smoothed by the local empirical Bayesian method. The global and local Moran indexes evaluated spatial autocorrelation. Individuals’ profiles were described and the characteristics of the cases with and without fixed residence were compared by Pearson’s chi-square or Fisher’s exact tests.

RESULTS

We analyzed 6,092 new cases of TB-HIV co-infection (5,609 with fixed residence and 483 without fixed residence). The proportion of TB-HIV co-infection ranged from 10.5% to 13.7%, with a drop of 3.0% per year (95%CI -3.4 – -2.6) and was higher in individuals without fixed residence. Incidence rates decreased by 3.6% per year (95%CI -4.4% – -2.7%), declining from 7.0 to 5.3 per 100,000 inhabitants/year. Co-infection showed positive and significant spatial autocorrelation, with heterogeneous spatial pattern and a high-risk cluster in the central region of the municipality. Cure was achieved in 55.5% of cases with fixed residence and in 32.7% of those without a fixed residence.

CONCLUSIONS

The data indicate an important advance in the control of TB-HIV co-infection in the period analyzed. However, we identified areas and populations that were unequally affected by the disease and that should be prioritized in the improvement of actions to prevent and control co-infection.

Tuberculosis; HIV infections, epidemiology; Spatial analysis; Time series studies

Characteristics of cases TB-HIV co-infection	With fixed residence		No fixed residence		Total
	(n = 5.609)		(n = 483)		(n = 6.092)
	n	%	n	%	n	%
Gender							< 0.001
Female	1,601	28.5	83	17.2	1,684	27.6
Male	4,008	71.5	400	82.8	4,408	72.4
Race/color							< 0.001
White	2,284	40.7	118	24.4	2,402	39.4
Black or brown	2,170	38.7	247	51.1	2,417	39.7
Others	45	0.8	02	0.4	47	0.8
Information ignored	1,110	19.8	116	24.0	1,226	20.1
Age group							0.087
0 to 19 years old	146	2.6	04	0.8	150	2.5
20 to 39 years old	2,856	50.9	253	52.4	3,109	51.0
40 to 59 years old	2,411	43.0	210	43.5	2,621	43.0
60 years or older	190	3.4	13	2.7	203	3.3
Information ignored	06	0.1	03	0.6	09	0.1
Years of schooling							< 0.001
None	93	1.7	17	3.5	110	1.8
From 1 to 7 years	1,729	30.8	159	32.9	1,888	31.0
8 years or more	2,280	40.7	108	22.4	2,388	39.2
Information ignored	1,507	26.9	199	41.2	1,706	28.0
Diagnostic form/location							< 0.001
Emergency room or hospital	3,686	65.7	301	62.3	3,987	65.4
Outpatient services	1,683	30.0	118	24.4	1,801	29.6
Diagnostic after death	140	2.5	26	5.4	166	2.7
Active search or contact investigation	58	1.0	35	7.2	93	1.5
Information ignored	42	0.7	03	0.6	45	0.7
Clinical form ^a							< 0.001
Pulmonary	3,202	57.1	362	75.1	3,564	58.5
Extrapulmonary	1,337	23.8	54	11.2	1,391	22.8
Pulmonary and extrapulmonary or disseminated	1,070	19.1	66	13.7	1,136	18.7
Associated diabetes	107	1.9	12	2.5	119	2.0	0.379
Associated mental disorder	58	1.0	09	1.9	67	1.1	0.094
Associated alcoholism	539	9.6	142	29.4	681	11.2	< 0.001
Associated smoking	146	2.6	28	5.8	174	2.9	< 0.001
Associated drug addiction	544	9.7	154	31.9	698	11.5	< 0.001
Treatment conclusion ^b							< 0.001
Cure	3,018	55.5	145	32.7	3,163	53.8
Death	1,212	22.3	111	25.1	1,323	22.5
Drop out	1,043	19.2	173	39.1	1,216	20.7
Failure or resistance	41	0.8	-	0.0	41	0.7
Transfer to another state/country	58	1.1	05	1.1	63	1.1
Treatment unconcluded or ignored	65	1.2	09	2.0	74	1.3

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Roberta Figueiredo Cavalin Instituto de Infectologia Emílio Ribas - Serviço de Epidemiologia Avenida Doutor Arnaldo, 165 01246-900 Pacaembu, São Paulo, SP