Profile and follow-up of patients with tuberculosis in a priority city in Brazil

Pereira, Jisleny da Cruz; Silva, Marcio Roberto; Costa, Ronaldo Rodrigues da; Guimarães, Mark Drew Crosland; Leite, Isabel Cristina Gonçalves

doi:10.1590/S0034-8910.2015049005304

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Sumário

Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005304 copy

Profile and follow-up of patients with tuberculosis in a priority city in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes.

METHODS

This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups.

RESULTS

Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively).

CONCLUSIONS

A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality.

Tuberculosis, therapy; Patient Dropouts, statistics & numerical data; Medication Adherence; Treatment Outcome; Epidemiological Surveillance; Disease Notification; Underregistration

Variable	Follow-up				p

	Indirect		Direct

	n	%	n	%
Gender
Male	143	65.9^a	200	69.7^b	0.41
Female	74	34.1^a	87	30.3^b
Age (years)
≤ 38	119	54.9^a	150	52.3^b	0.75
> 38	98	45.1^a	133	46.3^b
Incomplete^c	0	0.0^a	4	1.4^b
Race
White	70	32.3^a	74	25.8^a	0.13
Black/Mixed	80	36.8^a	120	41.8^a
Incomplete data^c	67	30.9^a	93	32.4^a
Educational level
None to complete primary school	87	40.0^a	168	58.5^b	0.47
High school to complete college education	44	20.3^a	70	24.4^b
Incomplete data^c	86	39.7^a	49	17.1^b
HIV diagnosis
Positive	40	18.4^a	30	10.4^b	0.11
Negative	134	61.7^a	158	55.1^b
Testing not conducted^c	35	16.2^a	89	31.0^b
In process	8	3.7^a	10	3.5^b
City of residence
Juiz de Fora	196	90.3^a	247	86.1^b	0.47
Others	21	9.7^a	34	11.8^b
Not informed^c	0	0.0^a	6	2.1^b

Characteristic	n	%
Reference center
Center 1^b	118	41.2
Center 2^c	2	0.7
Center 3^d	129	44.9
Center 4^e	15	5.2
Incomplete data	23	8.0
Hospitalized at some stage of treatment
Yes	178	62.0
No	109	38.0
Means of entering the health care service
New case	231	80.5
Relapse/readmission after treatment default	50	17.4
Incomplete data	6	2.1
Treatment scheme used
Scheme I – basic (RHZ)	250	87.2
Scheme IR – reinforced (basic + E)	19	6.7
Scheme II – meningoencephalic encephalitis	1	0.3
Scheme III – treatment failure (SZEEt)	3	1.0
Scheme for MDR	1	0.3
Incomplete data	13	4.5
Clinical presentation
Pulmonary	231	80.5
Extrapulmonary	49	17.1
Pulmonary and extrapulmonary	7	2.4
Type of presumptive diagnosis
Positive smear (bacilloscopy)	216	75.3
Positive culture	17	5.9
Histopathological examination suggestive of TB	52	18.1
Readmission with prior positive bacilloscopy	2	0.7
Institutionalized
Yes (penitentiary, nursing home, shelters)	27	9.4
No	220	76.6
Incomplete data	40	14.0
DOTS
Yes	150	52.3
No	113	39.4
Incomplete data	24	8.3
Alcoholic beverages in the last year until the beginning of treatment
Excessive drinking (CAGE 3-4)	72	25.1
Moderate drinking (CAGE 0-2)	63	22.0
Never drank or did not drink in the last year	85	29.6
Incomplete data	67	23.3
Smoking history
Smokers	109	38.0
Ex-smokers	76	26.5
Never smoked	52	18.1
Incomplete data	50	17.4
Use of illegal drugs
Current users	46	16.0
Ex-users	23	8.0
Only experimented	14	4.9
Never used	142	49.5
Incomplete data	62	21.6
Marijuana use in the last year
Yes	25	8.7
Never used or did not use in the last year	196	68.3
Incomplete data	66	23.0
Cocaine use in the last year
Yes	23	8.0
Never used or did not use in the last year	198	69.0
Incomplete data	66	23.0
Crack use in the last year
Yes	23	8.0
Never used or did not use in the last year	199	69.4
Incomplete data	65	22.6

Outcome			Follow-up				Relative Risk	95%CI	p

	SINAN^a		Indirect		Direct

	n	%	n	%	n	%
Cure	418	82.9	180	82.9	172	59.9^b	1.38	1.23;1.54	< 0.001
Treatment default	16	3.2	7	3.2^b	53	18.5	5.72	2.65;12.34	< 0.001
Deaths	42	8.3	18	8.3	22	7.7^b	1.08	0.59;1.96	0.92
Transfer	3	0.6	1	0.5^b	23	8.0	17.39	2.36;127.8	< 0.05
Failure	3	0.6	1	0.5^b	11	3.8	8.31	1.08;63.92	< 0.05
Incomplete data	22	4.4	10	4.6	6	2.1^b	2.20	0.81;5.97	0.18
Total	504	100	217	100	287	100

Closures			Follow-up				Relative Risk	95%CI	p

	SINAN^a		Indirect		Direct

	n	%	n	%	n	%
Cure	362	86.1	164	86.3	152	65.8^b	1.31	1.17;1.46	< 0.001
Treatment default	9	2.1	4	2.1^b	40	17.3	8.22	2.99;22.58	< 0.001
Deaths	31	7.3	14	7.4	17	7.3^b	1.00	0.50;1.97	0.85
Transfer	3	0.7	1	0.5^b	12	5.2	9.87	1.29;75.21	< 0.05
Failure	0	0.0	0	0.0^b	5	2.2	9.05	0.50;162.7^c	0.09
Incomplete data	16	3.8	7	3.7	5	2.2^b	1.70	0.54;5.27	0.52
Total	421	100	190	100	231	100

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: Marcio Roberto Silva. Rua Eugênio do Nascimento, 610 Dom Bosco. 36038-330 Juiz de Fora, MG, Brasil. E-mail:marcio-roberto.silva@embrapa.br