Impact of community-based adherence support on treatment outcomes for tuberculosis, leprosy and HIV/AIDS-infected individuals in post-Ebola Liberia.

BACKGROUND: Partners In Health (PIH) committed to improving health care delivery in Maryland County, Liberia following the Ebola epidemic by employing 71 community health workers (CHWs) to provide treatment support to tuberculosis (TB), HIV and leprosy patients. PIH simultaneously deployed a socioeconomic assistance program with three core components: transportation reimbursement to clinics; food support; and additional social assistance in select cases. OBJECTIVE: This study aimed to evaluate how a CHW program for community treatment support and addressing socioeconomic barriers to care can impact patient outcomes in a post-conflict and post-epidemic context. METHODS: Retrospective observational study utilizing registry data from 513 TB, 447 HIV and 75 leprosy patients at three health facilities in Maryland County, Liberia. Treatment coverage and clinical outcomes for patient cohorts enrolled in the pre-intervention period (January 2015 to June 2015) and the post-intervention period (July 2015 to July 2017) are compared using logistic regression analyses. RESULTS: TB treatment coverage increased from 7.7% pre-intervention to 43.2% (p < 0.001) post-intervention and lost to follow-up (LTFU) rates decreased from 9.5% to 2.1% (p = 0.003). ART treatment coverage increased 3.8 percentage points (p = 0.03), with patient retention improving 63.9% to 86.1% (p < 0.001); a 6.0 percentage point decrease in HIV LTFU was also observed (p = 0.21). Despite an 84.3% treatment success rate observed for leprosy patients, pre-intervention data was largely unavailable and statistical significance could not be reached for any treatment outcomes pre-post intervention. CONCLUSIONS: The PIH approach to CHW community treatment support in Liberia demonstrates how, with the right inputs, excellent clinical outcomes are possible even in post-conflict and post-epidemic contexts. Care should be taken to position and support CHWs so that they have the opportunity to succeed, including full integration and recognition within the system, and the addition of clinical system improvements and social supports that are too often dismissed as unsustainable.

Fatores relacionados ao abandono ou interrupção do tratamento da hanseníase: uma revisão integrativa daliteratura / Factors related to abandonment or interruption of leprosy treatment: an integrative literature review

Objetivo: identificar e analisar as evidências científicas que retratam os fatores relacionados ao abandono de tratamento da hanseníase. Metodologia: os artigos foram selecionados a partir das seguintes bases de dados: LILACS, Medline, SCiELO, CAPES e Ibecs, com data de publicação entre 2000 a 2013. Foram elencadas 11 publicações que abordam quais os fatores ligados a não adesão e/ou abandono de tratamento da hanseníase.Resultados: entre os artigos selecionados foram apontadas como principais fatores: regime terapêutico prolongado e efeitos adversos dos medicamentos; religião e crenças; conhecimento do paciente acerca da doença; relações entre paciente e equipe de saúde; apoio familiar; estigma social; e condições socioeconômicas do usuário. A revisão integrativa evidenciou ainda que a maior parte das pesquisas foi realizada no Brasil, exceto dois que foram publicados em língua espanhola (realizados na Índia). Todos os artigos tiveram abordagem quantitativa do tipo transversal. Conclusão: a revisão permitiu observar que há uma diferenciação conceitual entre não adesão e abandono do tratamento da doença, assim como evidenciou que tal problemática possui fatores multicausais e tem sido, nos últimos anos, pouco discutida e abordada através de pesquisas/ artigos relacionados diretamente ao tema.

Objective: to identify and analyze scientific evidences that demonstrate factors related to leprosy treatment abandonment. Methodology: the articles were selected from the following databases: LILACS, Medline, SCiELO, CAPES and Ibecs, published from 2000 to 2013. It was selected eleven publications that approach the factors related to non-adherence and / or abandonment of leprosy treatment. Results: among the selected articles were identified as main factors: prolonged therapeutic regimen and medication adverse effects;religion and beliefs; patient´s knowledge regarding the disease; relationships between patient and health care professionals; family support; social stigma; and user´s socioeconomic conditions. The integrative review also has shown that most of the researches was performed in Brazil, except for two that were published in Spanish(performed in India). All articles had a cross-sectional quantitative approach. Conclusion: the review allowed to observe that there´s a conceptual difference between non-adherence and abandonment of disease´streatment, also has evidenced that this problem is multifactorial and in recent years hasn´t been well discussed and approached through research / papers directly related to the theme.

Nocebo effect in Dermatology.

Nocebo effect, originally denoting the negative counterpart of the placebo phenomenon, is now better defined as the occurrence of adverse effects to a therapeutic intervention because the patient expects them to develop. More commonly encountered in patients with a past negative experience, this effect stems from highly active processes in the central nervous system, mediated by specific neurotransmitters and modulated by psychological mechanisms such as expectation and conditioning. The magnitude of nocebo effect in clinical medicine is being increasingly appreciated and its relevance encompasses clinical trials as well as clinical practice. Although there is hardly any reference to the term nocebo in dermatology articles, the phenomenon is encountered routinely by dermatologists. Dermatology patients are more susceptible to nocebo responses owing to the psychological concern from visibility of skin lesions and the chronicity, unpredictable course, lack of 'permanent cure' and frequent relapses of skin disorders. While finasteride remains the prototypical drug that displays a prominent nocebo effect in dermatologic therapeutics, other drugs such as isotretinoin are also likely inducers. This peculiar phenomenon has recently been appreciated in the modulation of itch perception and in controlled drug provocation tests in patients with a history of adverse drug reactions. Considering the conflict between patients' right to information about treatment related adverse effects and the likelihood of nocebo effect stemming from information disclosure, the prospect of ethically minimizing nocebo effect remains daunting. In this article, we review the concept of nocebo effect, its postulated mechanism, relevance in clinical dermatology and techniques to prevent it from becoming a barrier to effective patient management.

WHO multidrug therapy for leprosy: epidemiology of default in treatment in Agra district, Uttar Pradesh, India.

AIM: To study the magnitude of default, time of default, its causes, and final clinical outcome. METHODS: Data collected in active surveys in Agra is analyzed. Patients were given treatment after medical confirmation and were followed up. The treatment default and other clinical outcomes were recorded. RESULTS: Patients who defaulted have comparable demographic characteristics. However, among defaulters more women (62.7% in PB, 42.6% in MB) were seen than those in treatment completers (PB 52.7% and MB 35.9%). Nerve involvement was high in treatment completers: 45.7% in PB and 91.3% in MB leprosy. Overall default rate was lower (14.8%) in ROM than (28.8%) in standard MDT for PB leprosy (χ 1 (2) = 11.6, P = 0.001) and also for MB leprosy: 9.1% in ROM compared to 34.5% in MDT (χ 1 (2) = 6.0, P = 0.015). Default rate was not different (28.8% versus 34.5%, P > 0.05) in both types of leprosy given MDT. Most patients defaulted at early stage of treatment and mainly due to manageable side effects. CONCLUSION: The default in standard MDT both for PB and MB leprosy was observed to be significantly higher than in ROM treatment. Most defaults occurred at early stage of treatment and major contribution of default is due to side effects like drowsiness, weakness, vomiting, diarrhea, and so forth, related to poor general health. Although about half of the defaulters were observed to be cured 2.2% in PB-MDT and 10.9% of MB-MDT developed disability. This is an issue due to default. Attempts are needed to increase treatment compliance. The use of specially designed disease related health education along with easily administered drug regimens may help to reduce default.

Episódios reacionais hansênicos: estudo de fatores relacionados com adesão ao tratamento em uma unidade de referência / Leprosy rectional episodes: study of factores related to adherence to treatment in a unit of reference

As reações hansênicas são um dos maiores problemas para os profissionais de saúde no manejo dos portadores de hanseníase, tornando o controle das mesmas de fundamental importância para evitar complicações clínicas e sociais. A assiduidade às consultas para avaliação e controle é essencial para a cura. Este estudo avaliou a influência dos fatores sócio-demográficos e clínicos na adesão ao tratamento em estado reacional em um ambulatório de referência. Trata-sede um estudo do tipo série de casos, em pacientes em controle no ambulatório do NMT/UFPA nos anos de 2008 a 2009. Os resultados mostraram que pacientes do sexo masculino, adultos e com baixa escolaridade foram os mais acometidos pela hanseníase. As reações hansênicas do tipo 1(RR) foram as mais incidentes, tendo como principal queixa a dor. Apesar dos resultados não terem mostrado associação, com significância estatística, entre as variáveis estudadas e a não adesão ao tratamento, eles evidenciaram variáveis que interferem na assiduidade às consultas.

Leprosy reactions are one of the biggest problems for health professionals in the management of patients with leprosy, making control of these fundamentally important to avoid medical complications and social problems. The attendance to appointments for evaluation and control is essential to healing. This study evaluated the influence of socio-demographic and clinical factors in adherence to treatment in a reactive state in a outpatient referral. This is a study of type series of cases in patients in control in the outpatient department of the NMT / UFPA in the years 2008-2009. The results showed that male, adults and low education patients were the most affected by leprosy. Leprosy reactions of 1 (RR) type had the highest incidence, with pain as the chief complaint. Although the results have not shown an association with statistical significance between variables and non-adherence to treatment, they showed variables that interfere in attendance to appointments.

Knowledge of the patients regarding leprosy and adherence to treatment.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is known for its great disfiguring capacity and is considered an extremely serious disease to public health worldwide. The state of Ceará ranks 13th in number of cases of leprosy in Brazil, and fourth in Northeastern region, with an average of 2,149 new cases diagnosed every year. This study aimed to evaluate the knowledge of leprosy patients regarding treatment, and to assess the level of treatment adherence and its possible barriers. The study was conducted in the reference center for dermatology, from September 2010 to October 2010, in Fortaleza, Ceará. The study data were collected by means of a structured interview, along with the Morisky-Green test, in order to assess treatment adherence and barriers to adherence. A total of 70 patients were interviewed, out of whom 66 were new cases. The majority of patients were between 42 and 50 years old, and 37 (52.9%) were male. Most patients were clinically classified as presenting multibacillary leprosy (80%), and 78.6% of them were from Fortaleza, Brazil. The Morisky-Green test indicated that 62.9% of patients presented a low level of adherence (p<0.005), despite claiming to aware of the disease risks. However, it was observed that 57.1% of the patients had no difficulty adhering to treatment, while 38.6% reported little difficulty. This study shows that despite the patients claiming to be familiar with leprosy and its treatment, the Morisky-Green test clearly demonstrated that they actually were not aware of the principles of therapy, which is evidenced by the low degree of treatment adherence.

Childhood leprosy in a tertiary-care hospital in Delhi, India: a reappraisal in the post-elimination era.

OBJECTIVE: To assess the profile and describe the clinical presentations, clinico-histopathological profile, complications and treatment compliance of childhood leprosy at a tertiary care hospital in north-east district of Delhi during 2000-2009. DESIGN: A retrospective institutional study of children less than 14 years of age diagnosed with leprosy and registered in a leprosy clinic during 2000-2009. Demographic, clinical, investigative and treatment data was extracted from a pre-designed proforma. RESULTS: A total of 1790 cases of leprosy were registered during this period, of which 172 (9.6%) were children. The majority of patients (70.3%) were more than 11 years of age with a male preponderance. History of contact was present in 25 (14.5%) patients. Borderline tuberculoid (BT) was the commonest clinical type (70.3%) followed by tuberculoid (TT) seen in 5.8%, mid-borderline (BB) in 1.2%, borderline lepromatous (BL) in 9.9%, lepromatous (LL) in 4.1%, pure neural (PNL) in 4.6% and indeterminate in 4.1% cases. More than half (52.9%) patients had a single lesion. Nerve thickening was detected in 70% cases. Slit skin smears were positive in 34 (19.8%) patients. Eighty-nine (51.7%) children were classified as multibacillary (MB) and 83 (48.3%) as paucibacillary (PB) disease by NLEP criteria. Of the available biopsy records, clinico-histological correlation was observed in 130/151 (86.1%) patients. Lepra reactions were observed in 32 patients (18.6%), Type I in 29 cases and Type II in three cases. Neuritis occurred in 11 (6.4%) and deformities in 22 (12.8%) patients. Thirty-four (19-8%) children defaulted from treatment. Two patients relapsed. CONCLUSIONS: Despite the statistical elimination of leprosy in this region, childhood leprosy cases continue to present in alarming numbers. Our study confirmed that multibacillary disease and the complications of lepra reactions and deformities remain common in children. Early detection, treatment and contact tracing may be important reducing the burden of leprosy in the community. There is a need to continue leprosy control activities with full vigour even in areas where, statistically, it has been eliminated.

Adesão ao tratamento da Hanseníase: dificuldades inerentes aos portadores / Adhesion to Leprosy treatment: inherent difficulties of the patients / Adhesión al tratamiento de la Lepra: dificultades inherentes a los portadores

Esta pesquisa, realizada em Guaiúba, CE, Brasil, objetivou identificar as dificuldades de adesão ao tratamento pelos portadores de hanseníase, relacionando os fatores associados. Estudo qualitativo, cujos dados foram coletados a partir de uma visita domiciliária com roteiro de entrevista contendo sete questões norteadoras. Participaram pacientes com diagnóstico de hanseníase e histórico de não adesão ao tratamento. Utilizou-se o Modelo de Atividade de Vida de Roper, Logan e Tierney. As falas dos sujeitos foram categorizadas de acordo com as doze atividades de vida. A utilização do modelo possibilitou uma abordagem holística sobre as barreiras vivenciadas pelo hanseniano na adesão ao tratamento medicamentoso, de modo a conhecer as atividades de vida destes pacientes para possível adequação de ações voltadas a essa clientela.

This research, carried in Guaiúba, Ceará, Brazil aimed to identify the difficulties for the treatment compliance of leprosy patients, relating the associated factors. This is a qualitative study; data was collected from a home visit in January 2009 using an interview guideline containing seven guiding questions. Diagnosed leprosy patients with history of non compliance to treatment participated of the study. It was used Roper, Logan and Tierney's Model of Life Activities. The speeches of the subjects were classified according to twelve life activities. The model utilization made possible a holistic approach on the barriers lived by leprosy patients in the compliance to drug treatment, in order to know the life activities of these patients to a possible adaptation of the actions addressed to this clientele.

Esta investigación, llevada a cabo en Guaiúba, CE, Brasil, tuvo el objetivo de identificar las dificultades de la adhesión al tratamiento para las personas con lepra, relacionándoles a los factores associados. Estudio cualitativo, donde los datos fueron colectados a través de una visita domiciliaria mediante entrevista con siete preguntas guía. Participaron los pacientes con diagnóstico de lepra y con historia de no adherencia al tratamiento. Se ha utilizado el modelo de actividad de vida de Roper, Logan y Tierney. Los discursos de los sujetos fueron clasificados de acuerdo con las doce actividades de la vida. La utilización del modelo permitió un abordaje holístico acerca de las barreras experimentadas por los portadores de lepra en la adhesión al tratamiento farmacológico, de modo a conocer las actividades de vida de estos pacientes para posibles adecuaciones de acciones destinadas a esta clientela.

[Adhesion to leprosy treatment: inherent difficulties of the patients]. / Adesão ao tratamento da Hanseníase: dificuldades inerentes aos portadores.

This research, carried in Guaiúba, Ceará, Brazil aimed to identify the difficulties for the treatment compliance of leprosy patients, relating the associated factors. This is a qualitative study; data was collected from a home visit in January 2009 using an interview guideline containing seven guiding questions. Diagnosed leprosy patients with history of non compliance to treatment participated of the study. It was used Roper, Logan and Tierney's Model of Life Activities. The speeches of the subjects were classified according to twelve life activities. The model utilization made possible a holistic approach on the barriers lived by leprosy patients in the compliance to drug treatment, in order to know the life activities of these patients to a possible adaptation of the actions addressed to this clientele.

Long term sustainability and efficacy of self-care education on knowledge and practice of wound prevention and management among leprosy patients.

In a chronic disease like leprosy, assessment of self-care education of long duration is necessary to find out its effectiveness and to bring out sustainability both in the point of view of the provider and of the recipient. Self-care education was imparted to patients for 8 years in the Katpadi Block as part of 'prevention of impairment and disability' programme from the year 2000 onwards. The patients were provided with knowledge regarding 'inspection' for pre-disposing factors of wound development and about external causes (trauma) or dangerous environments for wound development. Additionally, they were given practice on self-care techniques for prevention and management of wounds. Staff as part of their routine work has been doing this. An evaluation, done by independent assessor, compared the effect of this programme with a control area where no such programme was going on. This showed that the self-care education resulted in very high level of knowledge and practice compared to the control area, even up to 100% practice in some aspects. Self-care education is effective, can be sustained for a long time and also can be carried out as part of routine work.

Integration of leprosy elimination into primary health care in orissa, India.

BACKGROUND: Leprosy was eliminated as a public health problem (<1 case per 10,000) in India by December 2005. With this target in sight the need for a separate vertical programme was diminished. The second phase of the National Leprosy Eradication Programme was therefore initiated: decentralisation of the vertical programme, integration of leprosy services into the primary health care (PHC) system and development of a surveillance system to monitor programme performance. METHODOLOGY/PRINCIPAL FINDINGS: To study the process of integration a qualitative analysis of issues and perceptions of patients and providers, and a review of leprosy records and registers to evaluate programme performance was carried out in the state of Orissa, India. Program performance indicators such as a low mean defaulter rate of 3.83% and a low-misdiagnosis rate of 4.45% demonstrated no detrimental effect of integration on program success. PHC staff were generally found to be highly knowledgeable of diagnosis and management of leprosy cases due to frequent training and a support network of leprosy experts. However in urban hospitals district-level leprosy experts had assumed leprosy activities. The aim was to aid busy PHC staff but it also compromised their leprosy knowledge and management capacity. Inadequate monitoring of a policy of 'new case validation,' in which MDT was not initiated until primary diagnosis had been verified by a leprosy expert, may have led to approximately 26% of suspect cases awaiting confirmation of diagnosis 1-8 months after their initial PHC visit. CONCLUSIONS/SIGNIFICANCE: This study highlights the need for effective monitoring and evaluation of the integration process. Inadequate monitoring could lead to a reduction in early diagnosis, a delay in initiation of MDT and an increase in disability rates. This in turn could reverse some of the programme's achievements. These findings may help Andhra Pradesh and other states in India to improve their integration process and may also have implications for other disease elimination programmes such as polio and guinea worm (dracunculiasis) as they move closer to their elimination goals.

Twenty five years follow up of MB leprosy patients retreated with a modified MDT regimen after a full course of dapsone mono-therapy.

BACKGROUND: The relentless emergence of dapsone resistance amongst M. leprae threatened leprosy control programmes, and increased the relapse rate of patients cured with dapsone monotherapy. OBJECTIVE: The study aimed to analyse the effect on the relapse rate of dapsone-cured multibacillary (MB) leprosy patients, of re-treatment, using a multidrug therapy (MDT) regimen which differed from the WHO recommended regimen. DESIGN: 794 MB leprosy patients who had been released from treatment after dapsone monotherapy were selected, amongst them 657 were re-treated for 1 year using the modified multidrug therapy regimen (mMDT) including rifampicin, clofazimine and dapsone, and 137 patients were observed as control cases. RESULTS: The regimen was well tolerated with good compliance: 620 patients completed re-treatment with mild side effects and a low incidence of leprosy reactions. There was a statistically significant difference between the relapse rates of re-treated and control groups (chi squaredf = 57.44, P < 0.001). Furthermore, the relapses in the re-treated group were significantly more likely to be later than those in the control group (t = 25.62, P < 0.001). CONCLUSIONS: Re-treatment with this modified regimen is acceptable and can reduce the risk of early relapse in dapsone-cured patients. The problem of persisters causing late relapse is likely to remain.

Digital neuropathy of the median and ulnar nerves caused by Dupuytren's contracture: Case report.

INTRODUCTION: Digital neuropathy is a pure sensory neuropathy of a digital nerve. It may be caused by acute or chronic local trauma or pressure, or accompany systemic illnesses such as rheumatoid disease, leprosy, Raynaud disease, dysproteinemia, or diabetes mellitus. We describe an extraordinary case of digital neuropathy of the median and ulnar nerves caused by Dupuytren contracture. CASE REPORT: A 56-year-old right-handed man was presented with numbness and tingling of the little finger of the right and ring finger of the left hand. The clinical and EMG findings in this patient were consistent with a lesion of the median and ulnar palmar digital nerves of the right and left ring and little fingers. CONCLUSION: Dupuytren tissue usually affects the palmar fascia, superficial to the digital nerves, and it may rarely affect the spiral cord in the digits. A spiral cord may cause sensory loss due to impingement of digital nerves or Dupuytren tissue may have been compressing the palmar digital nerves against the relatively inelastic deep transverse metacarpal ligament. As a result, digital neuropathy can develop in those with Dupuytren's contracture, and nerve conduction studies should also be performed to determine the condition. New studies are needed to provide better diagnostic criteria for the condition.

[Bibliographic production about adherence/non-adherence to therapy]. / Produção bibliográfica sobre adesão/não-adesão de pessoas ao tratamento de saúde.

Critical analysis of the Latin American bibliographical production over the last 10 years regarding the adherence/non-adherence to treatment of people with chronic health problems: leprosy, tuberculosis, hypertension, diabetes and AIDS. Thirty six articles were analyzed identifying the variables: year of publication, publication area and kind of study. Most of the articles (27) were produced by professionals of the medical area, in epidemiological studies, and of the nursing area (7) in qualitative and quanti-qualitative studies. The scientific production on the subject increased until 2002, when it began to drop. The authors repeatedly defended the idea that the role of the patient is to follow the recommendations of the health professional and that the patient is free to follow or not the treatment, the professional however being exempt from the responsibility for the consequences of this decision. The greater part of factors pointed out by the authors as contributing to non-adherence relates to the patient, showing that the major responsibility for the adherence / non-adherence to treatment is conferred upon him. The measures the authors indicate for solving the problem point to responsibility of professionals, health services, governments and teaching institutions.

Produção bibliográfica sobre adesão/não-adesão de pessoas ao tratamento de saúde / Bibliographic production about adherence/non-adherence to therapy

Análise crítica da produção bibliográfica latino-americana dos últimos dez anos, acerca da adesão/não-adesão ao tratamento de pessoas portadoras de problemas crônicos de saúde: hanseníase, tuberculose, hipertensão, diabetes e aids. Foram analisados 36 artigos, identificando-se as variáveis: ano de publicação, área de publicação e tipo de estudo. A maior parte dos artigos (27) foi produzida por profissionais da área de Medicina em estudos epidemiológicos e da área de Enfermagem (7) em estudos qualitativos e quanti-qualitativos. A produção científica sobre o assunto cresceu até 2002, caindo a partir desse ano. Nas definições descritas pelos autores, a idéia recorrente foi a de que o papel do paciente é o de ser submisso às recomendações dos profissionais de saúde e que ele tem autonomia para seguir ou não o tratamento, mas o profissional exime-se da responsabilidade sobre as conseqüências dessa decisão. A maioria dos fatores apontados pelos autores como contribuintes para a não-adesão está relacionada ao paciente, mostrando que a maior carga de responsabilidade pela adesão/não-adesão é conferida a ele. As medidas assinaladas pelos autores para a resolução do problema permitem a identificação da responsabilidade dos profissionais, serviços de saúde, governos e instituições de ensino.

Critical analysis of the Latin American bibliographical production over the last 10 years regarding the adherence / non-adherence to treatment of people with chronic health problems: leprosy, tuberculosis, hypertension, diabetes and AIDS. Thirty six articles were analyzed identifying the variables: year of publication, publication area and kind of study. Most of the articles (27) were produced by professionals of the medical area, in epidemiological studies, and of the nursing area (7) in qualitative and quanti-qualitative studies. The scientific production on the subject increased until 2002, when it began to drop. The authors repeatedly defended the idea that the role of the patient is to follow the recommendations of the health professional and that the patient is free to follow or not the treatment, the professional however being exempt from the responsibility for the consequences of this decision. The greater part of factors pointed out by the authors as contributing to non-adherence relates to the patient, showing that the major responsibility for the adherence / non-adherence to treatment is conferred upon him. The measures the authors indicate for solving the problem point to responsibility of professionals, health services, governments and teaching institutions.

[Evaluation and control of missing contacts of leprosy patients]. / Avaliação e controle de contatos faltosos de doentes com hanseníase.

Descriptive study, with qualitative variables, carried on in the Ambulatory of Specialties Region of Taubaté, in order to evaluate the missing contacts of leprosy patients. Thirty-six records of new cases were analyzed, from January 2003 to July 2004. Ninety-two contacts were identified, being 64.1% missing ones, having 25% from 20 to 29 years and 58.5% female. Of these, 61% were submitted to consultation of home nursing. Reported non-membership to the control for forgetfulness (66.6%), and lack of time (11.1%), 4 contacts had symptoms of leprosy, and 1 was confirmed (transmissible form - Dimorfa). Without achieving 100% coverage active search, we suggest, to ensure the goal of eliminating of the disease, partnerships and decentralization of the control activities.

Avaliação e controle de contatos faltosos de doentes com hanseníase / Evaluación y control de contactos faltantes de enfermos con lepra / Evaluation and control of missing contacts of leprosy patients

Estudo descritivo, com variáveis qualitativas, realizado no Ambulatório Regional de Especialidades de Taubaté, com objetivo de resgatar e avaliar contatos faltosos de doentes de hanseníase. Analisou-se 36 prontuários de casos novos, no período de janeiro de 2003 a julho de 2004. Identificou-se 92 contatos, sendo 64,1 por cento faltosos, tendo 25 por cento entre 20 a 29 anos e 58,5 por cento do sexo feminino. Destes, 61 por cento foram submetidos à consulta de enfermagem no domicilio. Relataram não adesão ao controle por esquecimento (66,6 por cento), e falta de tempo (11,1 por cento); 4 contatos tinham sintomas de hanseníase, e 1 foi confirmado (forma transmissível - Dimorfa). Sem atingir 100 por cento da cobertura de busca ativa, sugerimos, para assegurar a meta de eliminação da doença, parcerias e descentralização das ações de controle.

Descriptive study, with qualitative variables, carried on in the Ambulatory of Specialties Region of Taubaté, in order to evaluate the missing contacts of leprosy patients. Thirty-six records of new cases were analyzed, from January 2003 to July 2004. Ninety-two contacts were identified, being 64.1 percent missing ones, having 25 percent from 20 to 29 years and 58.5 percent female. Of these, 61 percent were submitted to consultation of home nursing. Reported non-membership to the control for forgetfulness (66.6 percent), and lack of time (11.1 percent), 4 contacts had symptoms of leprosy, and 1 was confirmed (transmissible form - Dimorfa). Without achieving 100 percent coverage active search, we suggest, to ensure the goal of eliminating of the disease, partnerships and decentralization of the control activities.

Estudio descriptivo, con cualitativas variable, realizado en el Ambulatorio de Especialidades Regional de Taubaté, a fin de canjear y evaluar las deficiencias de enfermos de lepra. Se analizaron los registros de 36 nuevos casos, entre enero de 2003 y julio de 2004. Se identificaron 92 contactos, sendo 64,1 por ciento deficiencias, tendo 25 por ciento de 20 a 29 años y 58,5 por ciento mujeres. De estos, 61 por ciento fueron sometidos a consulta en la casa de los enfermos . Informó de la no pertenencia al control en el olvido (66,6 por ciento), y la falta de tiempo (11,1 por ciento), 4 contactos había síntomas de la lepra, y se confirmó 1 (formulario transmisibles - Dimorfa). Sin lograr una cobertura del 100 por ciento del activo de búsqueda, le sugerimos que, para garantizar el objetivo de eliminar la enfermedad, las asociaciones y la descentralización de las actividades de control.