Treatment of drug-resistant tuberculosis in children and young adolescents in Brazil.

Introduction: Drug-resistant tuberculosis (DR-TB) is a global threat and a challenge for public health authorities worldwide. In children, the diagnosis is even more challenging and DR-TB is poorly described in the literature, as are its treatment outcomes. In this study, we aimed to describe the treatment of drug-resistant TB in children and young adolescents in Brazil. Methods: A descriptive epidemiological study of treatment for DR-TB in children under 15 years of age in Brazil between 2013 and 2020. The primary data source was the Information System for Special Tuberculosis Treatments (SITE-TB). Categorical variables were analyzed using relative frequencies (%) and continuous variables by measures of central tendency to characterize the profile of the cases, namely: sociodemographic, clinical characteristics, procedures, tests performed and treatment success. In order to verify the distribution of cases, a spatial analysis was carried out based on the municipality where the cases resided. Results: Between 2013 and 2020, 19,757 tuberculosis (TB) cases occurred in children aged <15 years in Brazil, and 46 cases of treatment for DR-TB were reported during the same period (annual average of 6 cases). Of these, 73.9% were aged 10-14, 65.2% were male, 4.3% were HIV+ and 43.3% were underweight (BMI<18.5) at the start of treatment. 17.4% had previous contact with TB, 69.6% had primary resistance, 47.8% multidrug resistance. The median duration of treatment was 15 months. DOT and standardized treatment regimen were performed in 52.2% of cases. Bacilloscopy was performed for 97.8% (57.8% positive); culture for 89.1% (75.6% positive), rapid molecular test for 73.9% with proven resistance to rifampicin in 55.8%. Susceptibility testing revealed resistance mainly to isoniazid (87.8%) and rifampicin (60.6%). 73.9% of cases were successfully treated and one death was reported. Cases were treated in 26 Brazilian municipalities, with the majority in Rio de Janeiro (15) and São Paulo (4). Conclusion: DR-TB treatment was recorded in <1% of general TB cases in children and young adolescents, suggesting underreporting of drug-resistant cases in the country. Despite the low number of registered cases, the data reflect the situation of DR-TB in this population and describe important aspects of the problem, as the child needs comprehensive, individualized care, with support from different professionals. We recommend a strengthening of the country's referral services for the care of children with DR-TB so that surveillance and health care services can work together to identify and follow up cases.

Tuberculosis/HIV co-infection in Northeastern Brazil: Prevalence trends, spatial distribution, and associated factors.

INTRODUCTION: The objective was to analyze the prevalence trend, spatial distribution, and TB-HIV co-infection-associated factors in an endemic scenario for TB in Northeastern Brazil. METHODS: An ecological and temporal series study was conducted based on secondary data obtained from the Brazilian Notifiable Diseases Information System between January 2008 and December 2019. The prevalence rates were determined for each year and the average for the period. Prais-Winsten regressions were used for temporal variation analysis, scanning techniques were used to detect spatial clusters, and the Poisson regression model was used to explore the factors associated with the outcome. RESULTS: A total of 947 TB cases were reported, of which 501 (52.9%) underwent HIV testing, and of these, 73 were positive. The average prevalence was 20.0%, ranging from 1.5% in 2018 to 44.4% in 2009. A decreasing trend was found. Sixty-seven cases (92%) were geocoded, and two statistically significant (p < 0.005) high relative risk (RR) spatial clusters were detected. Statistically significant associations (p < 0.05) between the co-infection and variables such as male gender, living in the urban area, entry due to relapse, and case closure due to loss to follow-up were evidenced, and these variables constituted risk factors. CONCLUSIONS: A decreasing prevalence of TB-HIV co-infection has been found, as well as a heterogeneous spatial distribution with the formation of spatial clusters in urban areas characterized by socio-spatial inequalities associated with clinical-epidemiological factors. Such findings provide subsidies for rethinking health care activities and improving public policies for vulnerable populations.

The burden of alcohol, tobacco and others drugs among incarcerated population diagnosed with tuberculosis: time trends and spatial determinants in Southern Brazil.

BACKGROUND: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is a public health problem worldwide. It is estimated that 90% of the patients diagnosed with TB live in vulnerable environments with limited health resources, such as individuals living in correctional facilities. This study aimed to identify the consumption of alcohol, tobacco, and other drugs among prisoners diagnosed with TB and the spatial determinants and time trends of the phenomenon in southern Brazil. METHODS: A cross-sectional study using data from the Brazilian Notifiable Diseases Information System was carried out. TB cases confirmed from 2014 to 2018 in prisons located in Paraná, Brazil, were selected. The Prais-Winsten procedure was performed to identify time trends by calculating monthly rates and the percentage of monthly variation. The Seasonal-Trend by Loess decomposition method was used to verify the time series and trends. The spatial association was verified with the Getis-Ord Gi* technique, and the risk areas were identified using spatial scan statistics. RESULTS: A total of 1,099 TB cases were found in the studied population. The consumption of tobacco (n = 460; 41.9%), illegal drugs (n = 451; 41.0%), and alcohol (n = 179; 16.3%) stood out. An ascending trend was found for the consumption of alcohol (+ 19.4%/mo. (95%CI: 12.20-23.03)), tobacco (+ 20.2%/mo. (95%CI: 12.20-28.82)), and illegal drugs (+ 62.2%/mo. (95%CI: 44.54-81.97)). Spatial analysis revealed clusters for the use of alcohol, tobacco, and illegal drugs. CONCLUSIONS: This study advances knowledge presenting the burden of drug use and its typology among individuals diagnosed with TB in the prison system. There is a growing trend among patients to use drugs, especially illegal drugs. The clusters show differences between the places where the prisons are located.

Local action plan to promote access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus, Brazil: Analysis of the plan´s development, experiences, and impact through a mixed-methods study (2020).

BACKGROUND: The provision of care and monitoring of health are essential for indigenous Venezuelans from the Warao ethnic group, who are at risk of decimation. OBJECTIVE: Analyze a Local Action Plan (LAP) to promote access to the health system of indigenous Venezuelans from the Warao ethnic group (IVWEG) in Manaus, Brazil. METHOD: A mixed-methods study was performed. Quantitative data were collected to assess the provision of care and monitoring of health conditions in IVWEG through a survey that was self-completed by healthcare providers. Qualitative narrative data were collected to gain insight into IVWEG that seek care. We applied descriptive statistics, grouping analysis (GA) by hierarchical levels, and multiple correspondence analysis (MCA). Content analysis was applied to qualitative data. RESULTS: 106 healthcare providers participated in the study, with the following characteristics: 94 (88.7%) females, 67 (63.2%) pardo race/color, 40 (37.7%) working in primary healthcare, and 49 (46.2%) nurses. In addition, 43 (40.6%) of the healthcare providers reported providing care to IVWEG. Among the providers, 89 (84%) had received training for assisting IVWEG. Additionally, 30 IVWEG were enrolled for interviews in the qualitative phase. The barriers to seeking care were language, distance to health units, and lack of money for transportation. The LAP proved to facilitate access to the health system by indigenous Venezuelans from the Warao ethnic group in Manaus. The study contributed to knowledge on a LAP addressed to IVWEG and helped improved their access to the health system, providing appropriate training for healthcare providers and other relevant actors by implementing a coherent and consistent public health policy at the local level.