Perceptions of TB-HIV comorbidity among the Nomads in Adamawa State, Nigeria.

The recalcitrance of Mycobacterium tuberculosis (MTB) to eradication was related to achieving a nonreplicating (dormant) state and the increasing global burden of HIV coinfection. Consequently, understanding the knowledge and perception of the population at risk of tuberculosis-HIV infection is essential to designing a strategy of intervention embraced by the target population. A cross-sectional study was conducted among Nomads in Adamawa State, Nigeria. A multistage sampling technique was employed to recruit consented participants. Self-administered questionnaires were used to gather the required information from 4 nomadic schoolteachers in each selected school. Data were entered into a Microsoft Excel sheet where trends and tables of collated data were developed. The findings show that only 13.5% of the participants expressed the correct perceptions of the complementary relationship between HIV and TB. More people in government employment (35%) understand the coexisting relationship of TB-HIV infections. At the same time, cattle herders and crop farmers who practice the prevalent occupation lack knowledge of TB-HIV relatedness. Across gender, only a proportion of males (14.8%) than females (10.5%) were more likely to show an understanding of the complementary association of HIV and TB, and this difference showed statistical significance (p = 0.0001). In conclusion, male gender, education at a degree or professional level, and employment with the government are factors associated with positive perceptions of TB/HIV relatedness. Thus, there is a need to intensify communication to educate Nomads on HIV and TB-related issues.

Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa.

BACKGROUND: Unhealthy alcohol use is widespread in South Africa and has been linked to tuberculosis (TB) disease and poor treatment outcomes. This study used qualitative methods to explore the relationship between TB and alcohol use during TB treatment. METHODS: Focus group discussions (FGDs) were conducted with 34 participants who had previous or current drug-susceptible TB and self-reported current alcohol use. Eight interviews were conducted with healthcare workers who provide TB services in Worcester, South Africa. RESULTS: In this rural setting, heavy episodic drinking is normalized and perceived to be related to TB transmission and decreased adherence to TB medication. Both healthcare workers and FGD participants recommended the introduction of universal screening, brief interventions, and referral to specialized care for unhealthy alcohol use. However, participants also discussed barriers to the provision of these services, such as limited awareness of the link between alcohol and TB. Healthcare workers also specified resource constraints, while FGD participants or patients mentioned widespread stigma towards people with alcohol concerns. Both FGD participants and health providers would benefit from education on the relationship between TB and unhealthy alcohol use and had specific recommendations about interventions for alcohol use reduction. Healthcare workers also suggested that community health worker-delivered interventions could support access to and engagement in both TB and alcohol-related services. CONCLUSION: Findings support strengthening accessible, specialized services for the identification and provision of interventions and psychosocial services for unhealthy alcohol use among those with TB.

[Comparative assessment of the intensity of caries among dental patients of older age groups in need of removable prosthetics, registered by a phthisiatician and their perception of an artificial ageist situation.]

Improving the quality of life of older age groups is an urgent problem of medicine, including its components: gerontology, phthisiology and dentistry. The objectives of the study are: to establish the importance of tuberculosis as an infection that causes the intensity of caries among patients of older age groups; assessment using the Palmore scale of gerontological ageism «The ageism survey¼ and patients' perception of an artificial situation of age inequality. The study involved elderly (n=122) and senile (n=121) persons with partial secondary adentia who needed removable dentures. The control groups of older people included patients who denied being under the supervision of a phthisiologist, and the study groups confirmed this. To solve the first problem, a comparative assessment of the values of the components of the CPI index in the control and study groups was carried out. To solve the second problem, an artificial situation of age inequality was simulated in the process of dental admission. The results of its effects were evaluated based on the response of patients to questions № 9, 10 of the Palmor scale. The absence of a difference in the values of K and N components between the control and study groups indicates the absence of a significant effect of mycobacteria on the development of caries. The large values of component Y in the studied groups may indicate the detrimental effect of mycobacteria on periodontal disease. The absence of an increase in the intensity and stability of the perception of age inequality among patients who are under the influence of an artificially created situation proves the great effectiveness of background age inequality. At the same time, it is impossible to exclude the low sensitivity of the Palmor scale in the process of diagnosing age inequality in Russian society.

Coping efforts made: Psychological burden of people living with tuberculosis due to social stigma in society. A qualitative phenomenology study.

The psychological burden is greatly felt by people living with tuberculosis because the characteristics of the disease are very visible and very contagious, and the obligation to take the right dose of medication with long treatment. This is what makes tuberculosis a very stigmatic disease. The aim of this research is to explore the psychological burden felt by people living with tuberculosis due to social stigma by society and how coping efforts are made. This research uses a qualitative phenomenological design through in-depth face-to-face interviews which take place in a semi-structured manner with the hope of obtaining complete data. The purposive sampling method was used in this research with Participatory Interpretative Phenomenology analysis involving 25 participants consisting of 16 men and 9 women. This research produced several themes, including 1) "The Perception of stigma limiting space and time", 2) "The Opportunities for interpersonal interaction become narrow", 3) "The mental stress as a challenging emotion", and 4) " Expanding coping efforts". The psychological burden is felt by people living with tuberculosis because society's treatment is felt to be very discriminatory due to the social stigma that has developed in society so they lose the opportunity to interact with society. For that reason, they tried to explore some of the personal and environmental resources used to modify adaptive coping in resolving perceived psychological burdens. Given the possibility of ongoing stigma and discrimination during tuberculosis treatment programs, it is important to consider the psychological burden in this context, both on the general population and on groups affected by stigma.

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria.

BACKGROUND: Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance. OBJECTIVE: We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. METHODS: A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. RESULTS: Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. CONCLUSIONS: Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

Exploring Sex Differences in Risk Factors and Quality of Life Among Tuberculosis Patients in Herat, Afghanistan: A Case-Control Study.

Objectives: Tuberculosis (TB) is a significant public health concern in Afghanistan, with a high burden of disease in the western province of Herat. This study explored the risk factors of TB and TB's impact on the quality of life of patients in Herat. Methods: A total of 422 TB patients and 514 controls were recruited at Herat Regional Hospital and relevant TB laboratories between October 2020 and February 2021. Data was collected through interviews using a structured questionnaire and the SF-36 questionnaire. Descriptive statistics, chi-square tests, Multivariate General Linear Model, and logistic regression analysis were used to analyze the data. Results: The results showed that male sex (p = 0.023), chronic disease (p = 0.038), lower education levels (p < 0.001), and worse health status (p < 0.001) were significantly associated with higher odds of TB infection. The study also found that TB patients had significantly lower quality of life scores in almost all components (p < 0.05). Conclusion: This study provides important insights into the specific ways in which TB affects the wellbeing of patients in Afghanistan. The findings highlight the importance of addressing the psychological and social dimensions of TB.

Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study.

BACKGROUND: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. OBJECTIVE: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. METHODS: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. RESULTS: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox-based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as "being watched" while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. CONCLUSIONS: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care.

Willingness toward voluntary counseling and testing and associated factors among tuberculosis infected patients at public hospitals in Addis Ababa, Ethiopia.

Background: Voluntary counseling and testing for HIV has proven to be a highly effective and cost-efficient approach in many locations, yielding excellent results. It serves as a gateway to a range of HIV-related services, including the provision of antiretroviral drugs. Therefore, this study was aimed to assess the willingness toward VCT and associated factors among TB infected patients at Public Hospitals in Addis Ababa, Ethiopia; 2023. Methods: A facility-based cross-sectional study was undertaken at public hospitals in Addis Ababa from 1st to 30th of March 2023 with 235 participants using systematic random sampling. Trained data collectors employed a pretested data extraction tool for information gathering. Variables with p-value less than 0.05 in the multivariable logistic regression were considered statistically significant. Results: The prevalence of willingness toward VCT among TB infected patients was (78.3, 95%CI: 72.8, 83.4). Individuals with a primary education level (AOR: 6.32; 95%CI: 1.65, 24.25), government employees (AOR: 5.85; 95%CI: 1.78, 19.22) and private employees (AOR: 3.35; 95%CI: 1.12, 10.01), good knowledge of VCT (AOR: 3.12; 95%CI: 1.36, 7.16), perceived a higher risk (AOR: 6.58; 95%CI: 2.44, 17.73) and perceived stigma (AOR: 14.95; 95%CI: 4.98, 44.91) were factors associated with willingness toward VCT. Conclusion: The proportion of Tuberculosis infected patients expressing willingness toward Voluntary Counseling and Testing in this study was higher than in previous studies, it falls below the UNAIDS target of 90% of people knowing their HIV status. Notably, factors such as level of education, occupation, knowledge, perceived risk, and perceived stigma emerged as independent factors significantly associated with the willingness of TB-infected patients to undergo VCT. These findings underscore the importance of considering socio-demographic characteristics, knowledge levels, and psychosocial factors in designing strategies to enhance VCT acceptance among TB-infected individuals.

Analysis of Health-Related Quality of Life and Incurred Costs Among Human Immunodeficiency Virus, Tuberculosis, and Tuberculosis/HIV Coinfected Outpatients in Indonesia.

OBJECTIVES: A growing interest in healthcare costs and patients' health-related quality of life (HRQoL) exists in the context of the increasing importance of health technology assessment in countries with high numbers of the HIV and tuberculosis (TB) patient populations, such as Indonesia. This study aimed to analyze the HRQoL and out-of-pocket (OOP) costs of HIV, TB, and TB/HIV coinfected participants in a city in Indonesia with a high prevalence of HIV and TB. METHODS: A cross-sectional survey was conducted in the voluntary counseling and testing and lung clinics of Bekasi City Public Hospital (Indonesia) from January to March 2018. Patients' HRQoL was measured using the EQ-5D-5L questionnaire, whereas OOP costs were extracted from a semistructured questionnaire. RESULTS: Of the 460 eligible participants, 82% resided in the city, 48% of them were married, and their median age was 34 years. Less than half were insured, and more than half had no source of income. The median values of health utilities for participants with HIV, TB, and TB/HIV were perceived as potentially high (1.0, 0.9, and 0.8, respectively). The TB/HIV coinfected outpatients had the highest OOP costs (US$94.5), with the largest contribution coming from direct medical OOP expenditures. Taking loans from family members was adopted as a financial strategy to overcome inadequate household incomes and high treatment costs. CONCLUSION: This study suggests that TB/HIV coinfection potentially lowers HRQoL and increases healthcare costs and the need for economic analysis to underpin cost-effective treatment in such patients.

A qualitative exploration of the impact of the COVID-19 pandemic on gender-based violence against women living with HIV or tuberculosis in Timor Leste.

Violence against women or gender-based violence (GBV) is a significant public health issue facing women and girls in different settings. It is reported to have worsened globally during the COVID-19 pandemic. Despite the impact of the COVID-19 pandemic on increased violence against women in general, which has been reported in many settings globally, there is a paucity of evidence of its impact on violence against highly vulnerable women living with HIV or tuberculosis (TB). Using a qualitative design, this study aimed to explore the views and experiences of women living with HIV (n = 19) or TB (n = 23) in Timor Leste regarding the GBV they faced during the COVID-19 pandemic. They were recruited using the snowballing sampling technique. Data were collected using one-on-one, in-depth interviews and focus group discussions. The five steps of qualitative data analysis suggested in Ritchie and Spencer's analysis framework were employed to guide the analysis of the findings. Findings indicated that women in this study experienced intensified physical, verbal, sexual and psychological violence by their partners, spouses, in-laws, and parents or other family members during the COVID-19 pandemic. Several prominent risk factors that worsened violence against women during the pandemic were (i) HIV or TB-positive status, (ii) traditional gender roles or responsibilities and expectations, (iii) economic and financial difficulties reflected in the loss of jobs and incomes due to the pandemic, and (iv) individual factors such as jealousy and increased alcohol drinking developed during the lockdowns. The women's experience of GBV during the pandemic also led to various negative psychological impacts. The findings underscore the urgent need for multifaceted interventions to address GBV, which should encompass challenging traditional gender norms, addressing economic inequalities, and targeting individual-level risk factors. The findings also indicate the need for the development of robust monitoring and evaluation systems to assess the effectiveness of policies and interventions addressing GBV where the results can inform future improvement. The findings also indicate the need to include GBV in the protocol or guidelines for HIV and TB management. Future large-scale quantitative studies to capture the magnitude and specific drivers of GBV against women living with HIV and TB during the pandemic are recommended.

Conocimientos, actitudes y prácticas en pacientes con tuberculosis: una revisión sistemática de literatura / Knowledge, attitudes and practices in patients with tuberculosis: a systematic literature review

Introducción: La tuberculosis es una enfermedad infectocontagiosa de fácil tras-misión. Para su control, los conocimientos, actitudes y prácticas adecuadas son indis-pensables, así como los factores relevantes para la adherencia al tratamiento. Objetivo: Caracterizar las definiciones o los conceptos de las dimensiones de cono-cimientos, actitudes y prácticas en tuberculosis reportados en la literatura durante los últimos diez años. Materiales y métodos: Se realizó una revisión sistemática de la literatura bajo la metodología "Preferred Reporting Items for Systematic Reviews and Meta-Analy-ses". Inicialmente, se encontraron 1.720 posibles publicaciones, de las cuales, luego de la aplicación de los criterios de exclusión, quedaron 34 para ser incluidas en el análisis de esta revisión. Resultados: La mayoría de los estudios fueron publicados en el año 2018 y pre-dominaron las publicaciones en el continente africano. La caracterización de las di-mensiones se relaciona así: los conocimientos se definen como características de la enfermedad, las actitudes se relacionan con el estigma social hacia el paciente y las prácticas corresponden con la búsqueda de atención médica por parte del paciente. Conclusión: Se identificó la escasez de producción científica en donde se especifi-quen los conceptos de las dimensiones de conocimientos, actitudes y prácticas, que a su vez permitan el desarrollo de investigaciones de alto rigor y alcance metodológico, ya que las publicaciones realizadas e incluidas para este estudio tuvieron una evalua-ción de baja calidad.

Introduction: Tuberculosis is an infectious disease of easy transmission. For tuber-culosis's control, appropriate knowledge, attitudes, and practices are essential, as well as relevant factors for treatment adherence. Objective: To characterize the concepts of three dimensions ­knowledge, atti-tudes, and practices­ in tuberculosis reported in the literature during the last ten years. Materials and methods: A systematic review of the literature was carried out under the methodology "Preferred Reporting Items for Systematic Reviews and Me-ta-Analyzes". Initially, 1.720 possible publications were found, of which, after apply-ing the exclusion criteria, 34 remained to be included in this review. Results: Most studies were published in 2018, and publications on the African con-tinent predominated. The characterization of the dimensions is related as follows: knowledge was defined as the characteristics of the disease, attitudes were related with the social stigma towards the patient with TB, and practices were associated with seeking medical care by the patients with TB. Conclusion: There is a lack of publications on the definition of knowledge, atti-tudes and practices on tuberculosis, which hampers developing high impact research.

Association of adverse drug reaction to anti-tuberculosis medication with quality of life in patients in a tertiary referral hospital

Abstract INTRODUCTION: Adverse drug reactions can develop when using anti-tuberculosis medication, and the effects of the drugs can also significantly hinder the treatment of patients. METHODS: A cross-sectional survey was conducted in 73 patients using two standardized questionnaires and the World Health Organization Quality of Life-Bref. RESULTS: All patients reported the presence of adverse drug reactions, 71.6% of which are minor and 28.3% both major and minor. The global quality of life analysis showed that patients with tuberculosis have a good average (67.3%). CONCLUSIONS: There is an association between quality of life and adverse drug reaction, educational level, and vulnerability.

Perfil biopsicosocial del paciente con tuberculosis y factores asociados a la adherencia terapéutica+ / Biopsychosocial profile of the patient with tuberculosis and factors associated with therapeutic adherence

INTRODUCCIÓN: La resistencia antibiótica y una inadecuada adherencia terapéutica son fenómenos que favorecen la proliferación de la tuberculosis. Los cambios sociodemográficos nos desafían a conocer la realidad actual de la enfermedad a través de antecedentes que nos permitan contextualizar un nuevo escenario. OBJETIVO: Caracterizar el perfil biopsicosocial del paciente con tuberculosis y su relación con la adherencia terapéutica. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, correlacional. Muestra de 90 pacientes tratados en 35 Centros de Salud Familiar de los Servicios de Salud de Iquique, Metropolitano Norte, Concepción y Reloncaví. RESULTADOS: los componentes biopsicosociales como edad, antecedentes de enfermedad mental, autoestima, situación sentimental, pertenencia a grupos de riesgo, alcoholismo, drogadicción y situación de calle presentaron una relación estadísticamente significación con la adherencia terapéutica. CONCLUSIONES: La caracterización biopsicosocial del paciente con tuberculosis visibiliza nuevos factores relacionados con la adherencia que deben ser considerados para una atención interdisciplinaria.

BACKGROUND: Antibiotic resistance and inadequate therapeutic adherence are phenomena that promote the proliferation of tuberculosis. Sociodemographic changes challenge us to know the real situation of the disease and allows us to contextualize a new scenario. OBJECTIVE: To characterize the biopsychosocial profile of the patient with tuberculosis and its relationship to therapeutic adherence. MATERIAL AND METHOD: Descriptive, cross-sectional, correlational study. Sample of 90 patients treated at 35 Family Health Centers from the following Chilean Public Health Services: Iquique, Metropolitan northern (Santiago), Concepción and Reloncaví. RESULTS: Biopsychosocial components such as age, history of mental illness, self-esteem, sentimental status, belonging to risk groups, alcoholism, drug addiction and homeless situation presented a statistically significant relationship with therapeutic adherence. CONCLUSIONS: The biopsychosocial characterization of the TB patient evidence a new adherence-related factors that should be considered for interdisciplinary care.

Tuberculosis y vivencias: Una mirada desde la fenomenología / Tuberculosis and experiences: A look from the phenomenology / Tuberculose e experiências: um olhar da fenomenología

La tuberculosis no ha sido erradicada en la mayoría de los países, por tanto, los programas de control deben también construirse sobre la base del conocimiento resultante de enfoques como el fenomenológico y no solo sobre la perspectiva biologicista y epidemiológica. Estudio de las vivencias en tuberculosis erigido sobre la matriz epistémica fenomenológica. Los informantes fueron: Dos pacientes con tuberculosis y un familiar de paciente fallecido por tuberculosis luego de abandonado el tratamiento. Los entrevistados pertenecen a una familia en ciclo de nido vacío donde las inadecuadas condiciones de vida y trabajo fueron determinantes en la adquisición de la patología. También es escaso el conocimiento sobre la enfermedad, pero bueno el trato del equipo de salud. Se concluye que La tuberculosis constituye un acontecimiento vital estresante y puede no ser aceptado por la persona o su grupo familiar, su percepción tiene repercusiones distintas según el conocimiento sobre la enfermedad y factores de riesgo, así como de la fase del ciclo vital familiar en que se encuentre, la aceptación de la enfermedad, la adherencia al tratamiento, la red social de apoyo, la situación laboral, la seguridad social y el sistema de salud

Tuberculosis has not been eradicated in most countries; therefore, control programs must also be built on the basis of knowledge resulting from approaches such as the phenomenological and not only on the biologic and epidemiological perspective. Study of the experiences in tuberculosis erected on the phenomenological epistemic matrix. The informants were: Two patients with tuberculosis and one family member of a patient who died of tuberculosis after leaving the treatment. The interviewees belong to a family in an empty nest cycle where the inadequate living and working conditions were decisive in the acquisition of the pathology. There is also little knowledge about the disease, but good treatment of the health team. It is concluded that tuberculosis is a stressful life event and may not be accepted by the person or their family group, their perception has different repercussions depending on the knowledge about the disease and risk factors, as well as the phase of the family life cycle in which is found, acceptance of the disease, adherence to treatment, social support network, employment status, social security and health system

A tuberculose não foi erradicada na maioria dos países, portanto, programas de controle também deve ser construído com base em conhecimentos resultantes de abordagens fenomenológicas como e não apenas sobre o biologicista e perspectiva epidemiológica. Estudo das experiências em tuberculose erguidas sobre a matriz epistêmica fenomenológica. Os informantes foram: Dois pacientes com tuberculose e um membro da família de um paciente que morreu de tuberculose após deixar o tratamento. Os entrevistados pertencem a uma família em um ciclo de ninho vazio onde as condições de vida e trabalho inadequadas foram decisivas na aquisição da patologia. Há também pouco conhecimento sobre a doença, mas um bom tratamento da equipe de saúde. Conclui-se que a tuberculose é um evento de vida estressante e não pode ser aceite pela pessoa ou suas famílias, a sua percepção tem efeitos diferentes dependendo do conhecimento sobre a doença e fatores de risco, bem como a fase do ciclo de vida da família que encontra-se, aceitação da doença, adesão ao tratamento, rede de apoio social, situação empregatícia, previdência social e sistema de saúde

The impact of the diagnosis of tuberculosis through its social representations / El impacto del diagnóstico de la tuberculosis mediante sus representaciones sociales / O impacto do diagnóstico da tuberculose mediante suas representações sociais

ABSTRACT Objective: To identify people's way of acting after the diagnosis of tuberculosis, through their social representations about the disease. Method: Qualitative and descriptive study based on the Theory of Social Representations, in which 23 patients of a school health center in Belém, PA, Brazil, participated. The software ALCESTE was used to generate a class concerning the impact of the diagnosis in people's lives. Results: The dimension of a new reality caused by the diagnosis of tuberculosis is linked with the image of dirt, (process of objectification) communicable/mortal disease that exclude, causing sorrow, despair and revolt (dimension of the affections), reverberating in the patients' actions (dimension of action). Final considerations: global knowledge about tuberculosis, linking the knowledge of everyday life with the reified universe, pointing the multidimensionality of the phenomenon. The conclusion is that investing in the deconstruction of archaic beliefs about the tuberculosis that kills, replacing it with the curable tuberculosis, is necessary.

RESUMEN Objetivo: Identificar el modo de actuar de las personas ante el diagnóstico de la tuberculosis, a partir de sus representaciones sociales sobre la enfermedad. Método: Investigación cualitativa y descriptiva basada en la Teoría de las Representaciones Sociales, en que participaron 23 pacientes de un Centro de Salud Escuela en Belém (Pará, Brasil). Se utilizó el programa informático ALCESTE, que generó una clase referente al impacto del diagnóstico en la vida de las personas. Resultados: La dimensión de lo nuevo, derivada del diagnóstico de la tuberculosis, se articula a la imagen de suciedad, de enfermedad transmisible/mortal y que excluye (proceso de objetivación), causando tristeza, desespero e indignación (dimensión de los afectos), lo que repercute en las acciones (dimensión de la acción) de los pacientes. Consideraciones finales: Los pacientes tienen un conocimiento global sobre la tuberculosis, que articula saberes del cotidiano a los del universo reificado, señalando la multidimensionalidad del fenómeno. Se concluye acerca de la necesidad de invertir en la desconstrucción de creencias arcaicas de la tuberculosis que mata a la tuberculosis que tiene cura.

RESUMO Objetivo: Identificar o modo de agir das pessoas ante o diagnóstico da tuberculose, a partir de suas representações sociais sobre a doença. Método: Pesquisa qualitativa e descritiva embasada na Teoria das Representações Sociais, em que participaram 23 pacientes de um Centro de Saúde Escola em Belém (PA). Utilizou-se o software ALCESTE, gerando uma classe referente ao impacto do diagnóstico na vida das pessoas. Resultados: A dimensão do novo, decorrente do diagnóstico da tuberculose, se articula à imagem de sujeira, de doença transmissível/mortal e que exclui (processo de objetivação), causando tristeza, desespero e revolta (dimensão dos afetos), repercutindo nas ações (dimensão da ação) dos pacientes. Considerações finais: Os pacientes têm um conhecimento global sobre a tuberculose, articulando saberes do cotidiano aos do universo reificado, apontando a multidimensionalidade do fenômeno. Conclui-se sobre a necessidade de se investir na desconstrução de crenças arcaicas sobre a tuberculose que mata para a tuberculose que tem cura.

Sociodemographic and health profile of TB/HIV co-infection in Brazil: a systematic review / Perfil Sociodemográfico y de salud de la coinfección tuberculosis/VIH en Brasil: revisión sistemática / Perfil Sociodemográfico e de saúde da coinfecção tuberculose/HIV no Brasil: revisão sistemática

ABSTRACT Objective: to ascertain the epidemiological profile of TB/HIV co-infection in Brazilian scenarios. Method: this is a systematic review conducted via electronic search in databases PubMed, EMBASE, LILACS and SciELO, having as inclusion criterion articles based on the Brazilian scenario of TB/HIV co-infection. Results: of the total 174 studies, 15 were selected, revealing the epidemiological profile of the co-infection in different scenarios: male, economically active age, low education level, brown/black ethnicity, low income, heterosexual, pulmonary clinical form, alcoholism and Directly Observed Therapy. Conclusion: the sociodemographic and epidemiological profile of people with TB/HIV co-infection has an expected occurrence pattern, which corroborates articles found in the literature, either at national level or by grouping the studies according to region or state.

RESUMEN Objetivo: conocer la manera en que se presenta el perfil epidemiológico de la coinfección tuberculosis/VIH en escenarios brasileños. Método: se trata de una revisión sistemática realizada por medio de búsqueda electrónica en las bases de datos PubMed, EMBASE, LILACS y SciELO, y tiene como criterio de inclusión artículos de base nacional sobre la coinfección tuberculosis/VIH. Resultados: de un total de 174 estudios, se seleccionaron 15 que revelan el perfil epidemiológico de la coinfección en diferentes escenarios brasileños: sexo masculino, edad económicamente activa, baja escolaridad, color de piel pardo/negro, baja renta, heterosexual, forma clínica pulmonar, alcoholismo y realización de Tratamiento Directamente Observado. Conclusión: el perfil sociodemográfico y epidemiológico de personas que presentan la coinfección TB/VIH tiene un estándar de incidencia esperado, corroborado por hallazgos en la literatura, ya sea en el ámbito nacional o por agrupamiento de los estudios por región o estado.

RESUMO Objetivo: conhecer como se apresenta o perfil epidemiológico da coinfecção tuberculose/HIV em cenários brasileiros. Método: trata-se de uma revisão sistemática realizada por meio de busca eletrônica nos bancos de dados PubMed, EMBASE, LILACS e SciELO, tendo como critério de inclusão artigos de base nacional sobre a coinfecção tuberculose/HIV. Resultados: do total de 174 estudos, 15 foram selecionados, revelando o perfil epidemiológico da coinfecção em diferentes cenários brasileiros: sexo masculino, idade economicamente ativa, baixa escolaridade, cor parda/negra, baixa renda, heterossexual, forma clínica pulmonar, alcoolismo e realização de Tratamento Diretamente Observado. Conclusão: o perfil sociodemográfico e epidemiológico de pessoas que apresentam a coinfecção TB/HIV possui um padrão de ocorrência esperado, que corrobora com achados da literatura, seja em nível nacional ou por agrupamento dos estudos por região ou estado.

Social incentives for adherence to tuberculosis treatment / Incentivos sociales en la adhesión al tratamiento de la tuberculosis / Incentivos sociais na adesão ao tratamento da tuberculose

ABSTRACT Objective: To analyze the influence of social incentives for adherence to tuberculosis (TB) treatment. Method: Qualitative study, in which 26 primary health care professionals of São Paulo were interviewed in 2015.Their testimonies were submitted to the speech analysis technique. The theoretical reference was the social determination of the health-disease process. Ethical procedures were observed. Results: TB is related to precarious living conditions. Incentives such as the basic food basket and transportation stipends are relevant for patients' adherence to treatment, as well as to the create bonds between the patient and the health team. Final considerations: The incentives strengthened adherence to TB treatment. However, interventions in the context of public measures must transcend the remedial dimension and be guided towards the transformation of the TB situation, which means supporting processes that modify living conditions.

RESUMEN Objetivo: Analizar la influencia de los incentivos sociales en la adhesión al tratamiento de la tuberculosis (TB). Método: Estudio cualitativo, en el que 26 profesionales de la Atención Primaria a la Salud del municipio de São Paulo fueron entrevistados en 2015, y sus testimonios fueron sometidos a la técnica de análisis de discurso. El referencial teórico fue la determinación social del proceso salud-enfermedad. Se han resguardado los procedimientos éticos. Resultados: La TB se relaciona con las condiciones precarias de la vida, siendo que los incentivos como la canasta básica y la ayuda para el transporte son relevantes para la adhesión del paciente al tratamiento, así como para el vínculo entre el paciente y el equipo de salud. Consideraciones finales: Los incentivos fortalecen la adhesión al tratamiento de la TB. Sin embargo, las intervenciones en el marco de medidas públicas deben trascender la dimensión paliativa y orientarse para transformar la situación de la TB, lo que significa apoyar procesos que modifiquen las condiciones de vida.

RESUMO Objetivo: Analisar a influência de incentivos sociais na adesão ao tratamento da tuberculose (TB). Método: Estudo qualitativo, em que 26 profissionais da Atenção Primária à Saúde do município de São Paulo foram entrevistados em 2015, e seus depoimentos foram submetidos à técnica de análise de discurso. O referencial teórico foi a determinação social do processo saúde-doença. Os procedimentos éticos foram resguardados. Resultados: A TB está relacionada às condições precárias de vida, sendo que incentivos como a cesta básica e o vale-transporte são relevantes para a adesão do paciente ao tratamento, assim como para o vínculo entre o paciente e a equipe de saúde. Considerações finais: Os incentivos fortalecem a adesão ao tratamento da TB. Contudo, intervenções no âmbito de medidas públicas devem transcender a dimensão paliativa e orientarem-se para transformar a situação da TB, o que significa apoiar processos que modifiquem as condições de vida.

Directly observed treatment for tuberculosis in the State of São Paulo / Tratamiento directamente observado de la tuberculosis en el Estado de São Paulo / Tratamento diretamente observado da tuberculose no Estado de São Paulo

ABSTRACT Objectives: To describe and analyze the coverage profile of directly observed treatment for tuberculosis in 59 priority municipalities in the state of São Paulo, Brazil, through the creation and comparison of groups homogenized by the number of people in each municipality from 2006 to 2012. Method: Quantitative, epidemiological and descriptive study based on the data available in the EPI-TB and the Statistica 7.0 software databases. Results: The mean and standard deviation of directly observed treatment for the 59 priority municipalities of the state of São Paulo were 77.0 ± 24.3%. The coverage of directly observed treatment increased in 34 municipalities (57.6%) but decreased in 25 (42.4%). Conclusion: Some municipalities could not keep the coverage reached at some point. This coverage heterogeneity should be examined in detail by searching for possible reasons in political-management, technical-operational and funding dimensions.

RESUMEN Objetivo: Describir y analizar el perfil de cobertura del Tratamiento Directamente Observado (TDO) en 59 municipios relevantes del Estado de São Paulo/Brasil, mediante formación y comparación de subgrupos, homogeneizados por el número de habitantes/municipio, de 2006 a 2012. Método: Estudio cuantitativo, epidemiológico y descriptivo, utilizándose el Banco EPI-TB y el Statistica 7.0. Resultados: La media y el desvío estándar del TDO para los 59 municipios relevantes del Estado de São Paulo/Brasil fue del 77,0% ± 24,3. La cobertura del TDO resultó creciente en treinta y cuatro municipios (57,6%), aunque en veinticinco (42,4%) hubo una disminución del porcentaje de cobertura. Conclusión: Algunos municipios no consiguieron mantener la sustentabilidad de la cobertura alcanzada en algún momento. Esta heterogeneidad de cobertura necesita profundizarse, buscando las posibles explicaciones en las dimensiones político-gerenciales, técnico-operativas y de financiamiento de acciones en TB.

RESUMO Objetivo: Descrever e analisar o perfil da cobertura do Tratamento Diretamente Observado (TDO) em 59 municípios prioritários do Estado de São Paulo/Brasil, por meio da formação e comparação de subgrupos homogeneizados pelo número de habitantes/município, de 2006 a 2012. Método: Estudo quantitativo, epidemiológico e descritivo, utilizando-se o Banco EPI-TB e do Statistica 7.0. Resultados: A média e o desvio-padrão do TDO para os 59 municípios prioritários do Estado de São Paulo/Brasil foi de 77,0% ± 24,3. A cobertura do TDO foi crescente em trinta e quatro municípios (57,6%), porém, em vinte e cinco (42,4,houve uma diminuição da porcentagem de cobertura. Conclusão: Alguns municípios não conseguiram manter a sustentabilidade da cobertura alcançada em algum momento. Essa heterogeneidade de cobertura precisa ser aprofundada, buscando as possíveis explicações nas dimensões político-gerencial, técnico-operacional e do financiamento das ações em tuberculose (TB).

Causas de abandono do tratamento entre portadores de tuberculose / Reasons for treatment abandonment among tuberculosis patients

OBJETIVO: Identificar e analisar as causas de abandono do tratamento da tuberculose entre pacientes em retratamento, por abandono anterior. MÉTODOS: Estudo descritivo, transversal, constituído por análise qualitativa, realizado por meio de análise de prontuários, entrevistas e aplicação de questionários a pacientes que reingressaram no tratamento de tuberculose após abandono, no período de abril de 2013 a abril de 2014, no município de Belém (PA). RESULTADOS: Os fatores mais citados pelos pacientes como motivadores do abandono do tratamento de tuberculose foram: melhora dos sintomas após o início do uso dos medicamentos (seis respostas), uso de drogas ilícitas (cinco respostas), falta de conhecimento da tuberculose e de seu tratamento (três respostas), uso de bebidas alcoólicas (três respostas), falta de dinheiro para ir ao posto (3 respostas), problemas familiares e falta de apoio familiar (três respostas). Essas causas foram apontadas como os principais motivadores do não seguimento do tratamento, o que correspondeu a 63,9% de todas as respostas. CONCLUSÃO: Diversos fatores ocasionaram o abandono do tratamento da tuberculose. São necessárias mais ações que aumentem a compreensão e conhecimento da doença pelo paciente.(AU)

OBJECTIVE: To identify and analyze the causes of treatment abandonment among tuberculosis patients in retreatment due to previous abandonment. METHODS: A descriptive, cross-sectional study consisting of qualitative analysis, carried out through an analysis of medical records, interviews and questionnaires applied to patients who rejoined treatment of tuberculosis after abandonment, from April 2013 to April 2014, in the city of Belem, state of Para. RESULTS: The factors that are most cited by patients as causes of abandonment of TB treatment were: improvement of symptoms after the start of drug use (six answers), illicit drug use (five answers), lack of knowledge about tuberculosis and its treatment (three answers), the use of alcohol (three answers), lack of money to go to the hospital (three answers), family problems and lack of Family support (three answers). These causes are cited as the main reasons for not following the treatment, which corresponded to 63.9% of all responses. CONCLUSION: There are several factors that cause abandonment of tuberculosis treatment. More actions to increase patient understanding and knowledge of the disease are needed.(AU)

Discursos sobre a tuberculose: estigmas e consequências para o sujeito adoecido / Discourses on tuberculosis: stigma and consequences for the subject ill / Discursos sobre la tuberculosis: el estigma y las consecuencias para el enfermo

O adoecimento por tuberculose é um processo subjetivo, que afeta a busca pelos cuidados de saúde. Esta pesquisa objetivou investigar como discursos sobre a tuberculose afetam o sujeito adoecido em tratamento hospitalar. Utilizando a abordagem qualitativa, foram realizadas entrevistas, em 2009, no município de João Pessoa - PB, com 16 doentes, sendo a maioria do sexo masculino, com idade média de 37,5 anos e ensino fundamental incompleto. O material foi organizado no software Atlas.ti e tratado segundo o referencial teórico-metodológico da análise de discurso francesa. Observou-se que aposição discursiva dos doentes de tuberculose entrevistados remete a um lugar de passividade, devido às formações imaginárias que o significam como um sujeito sem direitos reclamados, sofrendo, assim, um processo de apagamento e interdição. Em conclusão, foi identificada a necessidade de serem desenvolvidos modos de desestigmatização do ser doente de tuberculose, mediante a problematização de discursos cristalizados, particularmente nas instituições de saúde.

Falling ill with tuberculosis is a subjective process, which affects recourse to health care. The objective of this study was to investigate how discourses about tuberculosis affect the subject with tuberculosis undergoing hospital treatment. Sixteen tuberculosis patients, most of them male, mean age 37.5 years and incomplete fundamental education were interviewed, on a qualitative approach, in João Pessoa, Paraíba State in 2009. The material was organized using Atlas.ti software and analyzed within the the oretical and methodological frame work of French discourse analysis. It was observed that the discursive position of tuberculosis patients refers to a place of passivity, due to the imaginary formations that signify themas subjects with rights that are not claimed, and who the refore suffer a process of erasure and exclusion. In conclusion weidentified a need to develop ways to end the stigma attached to being ill with tuberculosis, by questioning discourses thathave crystallized, particularly in health care institutions.

Enfermarse de tuberculosis es un proceso subjetivo que afecta el recorrer a la atención de salud. Esta investigación tiene como objetivo investigar cómo los discursos sobre la tuberculosis afectan al enfermo en tratamiento hospitalario. Hacien do uso de un enfoque cualitativo, se han realizado entrevistas en 2009, en la ciudad de João Pessoa -PB, junto a dieciséis enfermos, en su mayoría hombres, cuyo promedio de edad era de 37,5 años y que tenían educación primaria incompleta. El material se organizó en el software Atlas.ti y fue analizado de acuerdo con el marco teórico y metodológico de análisis del discurso francés. Se observó que la posición discursiva de los enfermos de tuberculosis entrevistados remite a un lugar de pasividad, debido a las formaciones imaginarias que lo significan como un individuo sin derechos reclamados, sufriendo así un proceso de invisibilidad y prohibición. En conclusión, se identificó la necesidad de desarrollar modos de desestigmatización del serenfermo de tuberculosis, mediante la problematización de discursos cristalizados, en particular en las instituciones de salud.