Equipes de Atenção Primária Prisional e a notificação de tuberculose no Rio Grande do Sul/Brasil / Primary Prison Care Teams and tuberculosis notification in Rio Grande do Sul/Brazil

Resumo Os objetivos deste artigo são descrever o processo de implementação das Equipes de Atenção Primária Prisional no Rio Grande do Sul, a frequência de notificações de tuberculose na população privada de liberdade e a relação cronológica entre ambas. Trata-se de uma pesquisa documental aninhada a um estudo transversal descritivo de série histórica. Foram analisadas as portarias de habilitação de Equipes de Atenção Primária Prisional e os números e os anos de notificação dos casos de tuberculose oriundos do Sistema Nacional de Agravos de Notificação no período de 2014 a 2020. O estado do Rio Grande do Sul foi pioneiro na municipalização e cofinanciamento da saúde prisional, o que resultou na implantação de 45 equipes, com cobertura aproximada de 54,5% das pessoas privadas de liberdade em regime fechado. As equipes notificaram, entre 2014 e 2020, 5.175 casos de tuberculose, com incremento progressivo da notificação de casos, assim como a implantação de novas equipes. A estratégia de implantação de Equipes de Atenção Primária Prisional, impulsionada pela Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional, mostrou-se de fundamental importância para o aumento de diagnósticos, notificações e controle da tuberculose no estado do Rio Grande do Sul.

Abstract This paper aims to describe the implementation process of the Prison Primary Care Teams in Rio Grande do Sul, the frequency of tuberculosis notifications in people deprived of liberty, and their chronological relationship. This documentary research is nested in a descriptive cross-sectional study of historical series. We analyzed the decrees on the qualification of Prison Primary Care Teams, the number, and the year of notification of tuberculosis cases from the National System of Notifiable Diseases from 2014 to 2020. The state of Rio Grande do Sul pioneered prison health municipalization and shared financing, which resulted in the implementation of 45 teams, covering approximately 54.5% of people deprived of liberty a closed regime. The teams notified 5,175 cases of tuberculosis from 2014 to 2020, with a progressive increase in the notification of cases and the implementation of new teams. The strategy of implementing Prison Primary Care Teams driven by the National Comprehensive Health Care Policy for People Deprived of Liberty in the Prison System was crucial for increasing TB diagnosis, notification, and control in Rio Grande do Sul.

Completude dos dados do sistema de informações de tuberculose de pessoas privadas de liberdade do Rio Grande do Sul, Brasil / Completeness of tuberculosis information system data from prisoners in the state Rio Grande do Sul, Brazil

Resumo A tuberculose (TB) apresenta incidências elevadas em todo o mundo, sendo ainda mais grave em pessoas privadas de liberdade (PPL). Foi avaliada a completude das notificações de TB de PPL no SINAN realizadas por equipes de atenção primária prisional (eAPP) ou por outros estabelecimentos de saúde do RS. Estudo descritivo, transversal, utilizando dados de notificações de PPL feitas no SINAN TB pelas eAPP ou por outros estabelecimentos de saúde, de janeiro de 2014 a novembro de 2018. Foi analisado o percentual de completude das variáveis: sexo, raça/cor, escolaridade, HIV, tipo de entrada, baciloscopia de escarro, cultura do escarro, Aids, tratamento antirretroviral durante o tratamento para a TB, tratamento diretamente observado (TDO), baciloscopia de 6º mês e situação de encerramento. Praticamente 53% dos casos de TB em PPL foram notificados por eAPP, e 47,1% foram notificados por outros estabelecimentos de saúde. Oitenta por cento das variáveis foram classificadas na categoria 4 (75,1% a 100% de completude). No entanto, as variáveis TDO e baciloscopia de 6º mês foram classificadas na categoria 3 (50,1% e 75% de completude). Embora não comprometa a notificação da TB no SINAN, a ausência de dados pode prejudicar a qualidade das informações sobre a doença.

Abstract Tuberculosis (TB) has a high incidence in several countries and is even more severe in prisoners. We evaluated the completeness of prisoners TB notifications in the Notifiable Disease Information System (SINAN) carried out by prison primary care teams (eAPP) or by other health facilities in the state of Rio Grande do Sul (RS). This descriptive cross-sectional study used prisoners data notifications in the SINAN TB by the eAPP or other health facilities from January 2014 to November 2018. We analyzed the percentage of completeness of the variables: gender, ethnicity, schooling, HIV, entry type, sputum smear, sputum culture, AIDS, ART during TB treatment, directly observed treatment (DOT), sixth-month smear, and closure status. Around 52.9% of TB cases in prisoners were reported by eAPP, and other health facilities reported 47.1% of the cases. Eighty percent of the variables were classified in category 4 (75.1% to 100% completeness). However, the DOT and sixth-month smear variables were classified into category 3 (50.1% and 75% completeness). While it does not compromise the notification of TB in the SINAN, the lack of data can impair the quality of information about the disease.

Rapid identification of Mycobacterium tuberculosis in cultures by molecular and immunological methods / Identificação rápida de Mycobacterium tuberculosis em culturas por método molecular e método imunológico

Objective: The study aimed to evaluate molecular and immunological methods and to propose a workflow using them for tuberculosis (TB) diagnosis routine. Methods: A cross-sectional retrospective study was performed, including 121 liquid cultures from a TB laboratory located in the extreme south of Brazil. All cultures were positive for Mycobacterium tuberculosis complex (MTBC) by in-house Polymerase Chain Reaction (PCR) using DNA extracted by the CTAB method (PCR-CTAB) for IS6110 detection. These cultures were subjected to faster tests than this one, the immunological MPT64 assay and the PCR using DNA extracted by thermal lysis method (PCR-TL), and these were evaluated for MTBC identification using PCR-CTAB as a reference method. Results: The sensitivity of MPT64 assay and PCR-TL to identify MTBC in positive cultures by PCR-CTAB were 73.6% (89/121) and 98.3% (119/121), respectively. We proposed a workflow based on the use of MPT64 assay in liquid cultures suggestive of MTBC, and in case of a negative result, we suggest the performance of PCR-TL. The PCR-CTAB is suggested only if faster tests are negative. Conclusions: Methods capable of confirming MTBC in cultures should continue to be standardized, tested, and optimized to meet the ideal requirements of simplicity, quickness, and effectiveness. The molecular and immunological methods evaluated have differences in the execution and detection of MTBC in cultures, but they are rapid tools for laboratory TB diagnosi

Objetivos: O estudo objetivou avaliar métodos molecular e imunológico e propor um fluxo de trabalho utilizando-os para a rotina de diagnóstico da tuberculose (TB). Métodos: Foi realizado um estudo transversal retrospectivo, incluindo 121 culturas líquidas de um laboratório de TB localizado no extremo sul do Brasil. Todas as culturas foram positivas para o complexo Mycobacterium tuberculosis (CMTB) por Reação em Cadeia da Polimerase (PCR) in-house para detecção do IS6110, usando DNA extraído pelo método CTAB (PCR-CTAB). Essas culturas foram submetidas a testes mais rápidos que este, o ensaio imunológico MPT64 e a PCR com DNA extraído pelo método de lise térmica (PCR-LT), e estas foram avaliadas para identificação de CMTB usando PCR-CTAB como método de referência. Resultados: A sensibilidade do ensaio MPT64 e da PCR-LT para identificar o CMTB em culturas positivas pela PCRCTAB foi de 73,6% (89/121) e 98,3% (119/121), respectivamente. Propusemos um fluxo de trabalho baseado no uso do ensaio MPT64 em culturas líquidas sugestivas de CMTB e, em caso de resultado negativo, sugerimos a realização de PCR-LT. Sugere-se a PCR-CTAB apenas se os testes mais rápidos forem negativos. Conclusões: Os métodos capazes de confirmar o CMTB em culturas devem continuar sendo padronizados, testados e otimizados para atender aos requisitos ideais de simplicidade, rapidez e eficácia. Os métodos molecular e imunológico avaliados apresentam diferenças na execução e detecção do CMTB em culturas, mas são ferramentas rápidas para o diagnóstico laboratorial da TB.

Tuberculosis in prison inmates in Southern Brazil: investigating the epidemiological and operational indicators

ABSTRACT Background: Tuberculosis is a worldwide public health problem and is more prevalent in specific populations, such as prisoners. The aim of this study was to analyze the epidemiological and operational indicators of tuberculosis in prisoners in a southern region of Brazil. Methods: This was a descriptive, observational study, utilizing secondary data from the Notifiable Diseases Information System on tuberculosis cases diagnosed in prisoners in the state of Rio Grande do Sul, southern Brazil, from 2014 to 2018. Prisoner data used to calculate incidence were extracted from reports by the National Penitentiary Department. Results: From 2014 to 2018, 3,557 tuberculosis cases were reported in Rio Grande do Sul prisoners. The incidence rate of tuberculosis in prisoners was 1,235/100,000 individuals in 2014 and 1,430/100,000 individuals in 2018. The proportion of new TB cases tested for HIV was high, 83.4% in this period; among those tested, 12.9% were HIV coinfected. The proportion of new cases of pulmonary tuberculosis confirmed by laboratory criteria was 52.6% in this period. In total, 18.4% of new pulmonary tuberculosis cases were initiated on directly observed treatment in this period, and 36.4% of contacts of new cases of pulmonary tuberculosis with laboratory confirmation were examined. Among retreatment pulmonary tuberculosis cases, 82.4% were laboratory-confirmed. Conclusions: Tuberculosis incidence is increasing on a per-capita and absolute basis in Rio Grande do Sul. Laboratory confirmation, HIV testing, directly observed treatment, and contact investigation rates were all low, indicating the need to improve medical and public health measures for tuberculosis control in prisons.

Epidemiology and control strategies for tuberculosis in countries with the largest prison populations

ABSTRACT Tuberculosis (TB) is a serious infectious disease, and its control is considered a challenge, especially among vulnerable populations such as prisoners. The occurrence of TB in prisons is an alarming public health problem in many countries. This integrative review aims to describe the epidemiology of TB and control strategies for this disease in countries with the largest prison populations. Studies have shown that it is essential to know the prevalence of TB in prisons of each country. This is because it can serve as an indication of the need for action in prisons to reduce TB rates, including improving the structure of prison environments, rapidly and accurately diagnosing new cases, identifying drug-resistant strains, and implementing effective and directly observed treatment for TB.

Tuberculosis among prison staff in Rio Grande do Sul / Tuberculosis entre los profesionales de las prisiones en Rio Grande do Sul / Tuberculose entre profissionais de penitenciárias do Rio Grande do Sul

ABSTRACT Objective: to evaluate the risk of infection and illness caused by Mycobacterium tuberculosis among health care and security staff in prisons in two regions of Rio Grande do Sul (RS). Method: cross-sectional study involving prison staff. An interview and sputum smear microscopy and culture were performed. Latent infection was evaluated according to the result of the tuberculin test (TT), self-referred. Results: among staff who had a TT, 10 (83.3%) in the central region and 2 (16.7%) in the southern region were considered reactors. Length of employment among prison officers who reacted to TT was 15.3 years, and among health care workers, 4.1 years (p = 0.01). No cases of active tuberculosis (TB) were identified. Conclusion: prevalence of latent TB was 27.9%. Length of employment between different professional categories and their working regions was considered a risk factor for latent TB.

RESUMEN Objetivo: evaluar el riesgo de infección y de la enfermedad por Mycobacterium tuberculosis entre los profesionales de la salud y seguridad en los centros penitenciarios en dos regiones del estado de Rio Grande do Sul (RS). Método: estudio transversal con la participación de profesionales de la prisión. Se llevó a cabo una entrevista, la baciloscopia y cultivo de esputo. La infección latente se evaluó de acuerdo con el resultado de la prueba de la tuberculina (TST) mediante auto-reporte. Resultados: entre los trabajadores que realizaron la TST en la región central, 10 (83,3%) fueron considerados reactores; y 2 (16,7%) en la región Sur. El tiempo de trabajo entre los agentes de la prisión con reacción a la TST fue de 15,3 años, y entre los trabajadores de la salud fue de 4,1 años (p = 0,01). No hubo casos identificados de la tuberculosis (TB) activa. Conclusión: la prevalencia de la TB latente fue del 27,9%. El tiempo de trabajo entre las diferentes categorías profesionales y la región en la que trabajan fueron considerados factores de riesgo para la TB latente.

RESUMO Objetivo: avaliar o risco de infecção e adoecimento por Mycobacterium tuberculosis entre profissionais de saúde e de segurança em casas penitenciárias de duas regiões do Rio Grande do Sul (RS). Método: estudo transversal, envolvendo profissionais de penitenciárias. Foi realizada uma entrevista, baciloscopia e cultura de escarro. A infecção latente foi avaliada de acordo com o resultado do teste tuberculínico (TT), auto-referido. Resultados: entre os trabalhadores que realizaram o TT na região central, 10 (83,3%) foram considerados reatores; e na região sul, 2 (16,7%). O tempo de trabalho entre os agentes penitenciários reatores ao TT foi 15,3 anos e entre os trabalhadores da saúde 4,1 anos (p = 0,01). Não foram identificados casos de Tuberculose (TB) ativa. Conclusão: a prevalência de TB latente foi 27,9%. O tempo de trabalho entre as diferentes categorias profissionais e a região em que trabalham foram considerados fator de risco para TB latente.

Latent tuberculosis among professionals from a referral hospital in oncology

Introduction: Tuberculosis (TB) is an ancient contagious disease, and continues to be the leading cause of morbidity and mortality among infectious contagious diseases. It can be considered an occupational infectious disease when it happens in health professionals. These professionals are directly exposed to TB and are considered to be a high risk population for latent tuberculosis infection (LTBI) and active TB. The primary aim of this study was to estimate the prevalence of LTBI among the clinical and administrative staff of an oncology referral hospital in Rio Grande do Sul. The secondary aim of this study was evaluate tuberculin skin test (TST) conversion rate and the risk factors for TST positivity in this population. Methods: A cross-sectional study was carried out in a retrospective cohort with data collected in March 2013 and March 2014. Data of professionals from different hospital units were included. Those with induration ≥ 10 mm were considered as reactors, and conversion rate was assessed by an increase ≥ 10 mm in induration in the second TST compared with the first one. Results: Among the 225 professionals evaluated in 2013, 135 (60%) were reactors and 90 (40%) were non-reactors. The mean age was 32.9 (± 9.55), 176 (78.22%) were female, and most of the reactors worked in the hospital for 4 years or less. Non-reactors in 2013 were recommended to repeat the test in 2014, and the conversion rate was 9.37%. There was no significant difference in prevalence among the different professional categories, and the assessed risk factors were not associated with ILTB. Conclusions: The prevalence of LTBI in the study population was high, reinforcing the need to implement effective control measures to prevent LTBI in the hospital where the study was conducted (AU)