Factors of abandonment of tuberculosis treatment in the public health network / Factores de abandono al tratamiento de la tuberculosis en la red pública de salud

ABSTRACT This study determines the factors of abandonment of tuberculosis treatment in the public health network of Cali, Colombia, during years 2016 to 2018. We conducted an operational case-control investigation including 224 patients with tuberculosis (112 abandoned treatment and 112 completed it). We found that treatment abandonment for tuberculosis is driven by factors related to the individuals and health services that facilitate non-adherence and drive them away from the care provided in medical institutions.

RESUMEN Este estudio determina los factores de abandono al tratamiento de la tuberculosis en la red pública de salud de Cali, Colombia, durante los años 2016 a 2018. Se realizó una investigación operativa de casos y controles en la que se incluyeron 224 pacientes con tuberculosis (112 abandonaron el tratamiento y 112 lograron completarlo). Se encuentra que el abandono del tratamiento para la tuberculosis está impulsado por factores relacionados con el individuo y los servicios de salud que facilitan la no adherencia y los alejan de la atención brindada en las instituciones médicas.

Assistência Farmacêutica em Moçambique: a ajuda externa na provisão pública de medicamentos / Pharmaceutical Services in Mozambique: foreign aid in public provision of medicines

Resumo Este artigo analisa a ação de atores nacionais e internacionais na Assistência Farmacêutica (AF) em Moçambique, no período de 2007 a 2012, com foco na provisão pública de medicamentos para HIV/Aids, malária e tuberculose. Descreve-se o funcionamento da AF no país; os atores que atuam nesse âmbito e as relações entre eles; discutem-se questões relevantes sobre o modus operandi dos parceiros de cooperação. A metodologia combinou: revisão bibliográfica, levantamento e análise documental e entrevistas. O marco teórico e analítico utilizou a análise de políticas públicas com foco no papel do Estado e suas inter-relações como os demais atores na ajuda externa na área farmacêutica e a abordagem de redes. Conclui-se que a interação entre os atores envolvidos é complexa, caraterizada pela fragmentação operacional e sobreposição de atividades entre diversos entes; centralização da aquisição de medicamentos na mão de poucos agentes; by pass das estruturas nacionais e desconsideração do necessário fortalecimento do sistema nacional de saúde para a construção de sua autonomia. A despeito de alguns avanços na provisão e disponibilidade de medicamentos para essas doenças, existe forte dependência externa nesse âmbito, o que obstaculiza a sustentabilidade da AF em Moçambique.

Abstract This article examines the activities of national and international actors in Pharmaceutical Services (PS) in Mozambique from 2007 to 2012, focusing on the public provision of HIV/Aids, malaria and tuberculosis medicines. It describes how PS functions in the country, what actors are involved in this area and the relations among them, pursuing salient issues in the modus operandi of partners in cooperation. The methodology combines literature review, document survey and analysis and interviews. The theoretical and analytical framework was given by the policy analysis approach, focusing on the role of the State and its interrelations with other actors in foreign aid in PS, and also by the networks approach. It was concluded that the interactions among the actors involved is complex and characterised by operational fragmentation and overlapping of activities between entities, centralised medicine procurement in the hands of few agents, bypassing of national structures and disregard for the strengthening needed to bolster national health system autonomy. Despite some advances in the provision and availability of medicines for these diseases, external dependence is strong, which undermines the sustainability of PS in Mozambique.

Tuberculosis control and the private sector in a low incidence setting in Argentina / Control de la tuberculosis y sector privado en un sitio de baja incidencia de Argentina

Objectives Determining private doctors' (PD) knowledge and practice regarding tuberculosis (TB) control issues and exploring the availability of TB drugs in private pharmacies (PP) in a low incidence setting in Argentina (Santa Fe). Methods A questionnaire was applied to random sample of 87 PPs and 61 PDs, proportionally assigned according to the local distribution of specialists and general practitioners. Their knowledge and practice were explored regarding the symptoms, diagnosis and case management of pulmonary TB, as defined and specified by Argentinean TB management guidelines. Results Although most PDs were aware of the main symptoms presented by TB, they were unlikely to ask for a microscope examination for a person suffering persistent cough. More than 30 percent of PDs considered X-ray before "microscope examination of stained sputa" for TB diagnosis. PDs had significantly lower levels of knowledge regarding the symptoms and diagnostic procedures for TB compared to those who combined public and private work. Most PDs (91,3 percent) referred their TB patients to a public facility for treatment. Accordingly, very few TB drug prescriptions were managed in PPs. Discussion Addressing mismanagement of TB patients in the private sector does not appear to be a problem in Santa Fe in terms of treatment (although being considered crucial for effective TB control) because most PDs are aware of the TB programme which appears to be comprehensive and accessible. The private sector's main aim should be to improve its skills regarding TB diagnosis.

Objetivos Determinar prácticas y conocimientos de los médicos privados (MP) acerca del control de la tuberculosis (TB) y explorar la disponibilidad de drogas anti-TB en farmacias privadas (FP) en un entorno de baja incidencia de TB de Argentina. Métodos Se realizó una encuesta por cuestionario sobre una muestra aleatoria de 87 FP y 61 MP, asignados proporcionalmente según la distribución local de médicos especialistas y generalistas. Se investigaron conocimientos y prácticas en relación a síntomas, diagnóstico y manejo de casos de TB, según lo especifican las normas. Resultados Aunque la mayoría de los médicos conocían los principales síntomas, era poco probable que solicitaran exámenes microscópicos de esputo (EME) en pacientes con tos persistente. Más del 30 por ciento de los MP priorizaron la radiografía de tórax por encima del EME para el diagnóstico de TB. Los médicos que sólo trabajaban en el sector privado tuvieron niveles significativamente más bajos de conocimientos que los que trabajaban tanto en el sector público como privado. La mayoría de los MP (91,3 por ciento) referían sus pacientes para tratamiento a un servicio público. Concordantemente, el número de recetas de medicamentos anti-TB manejados por las FP era muy pequeño. Discusión Si bien se considera que, la búsqueda de una solución para el manejo inadecuado de casos en el sector privado es crucial para un control efectivo de la TB, en Santa Fe, éste no parece ser un problema importante, ya que la mayoría de los MP conocen el Programa de Control, que aparece como accesible. El principal objetivo del sector privado debería ser mejorar sus habilidades para el diagnóstico.