The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021.

BACKGROUND: One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. METHODS: A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. RESULTS: We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). CONCLUSIONS: Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.

Protocol for pragmatic randomized clinical trial to evaluate the completion of treatment of latent Mycobacterium tuberculosis infection with Isoniazid in the 300 mg formulation.

INTRODUCTION: It is essential to strengthen the treatment of latent tuberculosis infection (LTBI) to break the chain of transmission. The drug used worldwide for the treatment of LTBI is Isoniazid. A clinical trial conducted in Brazil has demonstrated the bioequivalence of Isoniazid in the 300 mg formulation with 3 tablets in the 100 mg formulation. Further studies are needed to evaluate the completion of treatment with Isoniazid 300 mg single tablet. OBJECTIVE: Describing a protocol for a clinical trial to evaluate the completion of treatment of LTBI with the drug Isoniazid in 300 mg tablet formulation compared to the use of Isoniazid in 100 mg tablet formulation. METHODS: This is a pragmatic, multicenter, randomized, open-label clinical trial registered on the Rebec RBR-2wsdt6 platform. Individuals 18 years of age or older with an indication for treatment of LTBI will be included, with only 1 individual per family nucleus. Individuals whose index case of active TB is categorized as retreatment, multidrug-resistant and extremely resistant, individuals transferred from the original center two or more weeks after the onset of treatment, and persons deprived of liberty will be excluded. The study intervention will be the treatment of LTBI with 1 tablet of Isoniazid 300 mg. The control group will receive the treatment of LTBI with 3 tablets of Isoniazid 100 mg. Follow-up will be performed at month 1, month 2 and at the end of treatment. The primary outcome will be completion of treatment. CONCLUSION: It is expected that with the treatment with the 300 mg formulation, more patients will complete the treatment based on the complexity index of pharmacotherapy. Our study intends to substantiate theoretical and operational strategies that respond to the demand for incorporation of a new formulation of the drug for the treatment of LTBI in the Unified Health System network.

Percepção e experiência de profissionais da saúde sobre prevenção da tuberculose latente na atenção primária

Objetivo: Analisar a percepção e a experiência de profissionais da saúde sobre prevenção da Infecção Latente por Tuberculose (ILTB) no contexto da Atenção Primária. Material e Método: Estudo exploratório, descritivo, de abordagem qualitativa, realizado com oito profissionais de saúde da atenção primária, de três regiões do Brasil (Centro-Oeste, Sudeste e Sul) e do Distrito Federal. Os dados foram coletados por entrevista coletiva semiestruturada com a questão norteadora: Quais é a percepção e a experiência dos profissionais da atenção primária à saúde na prevenção da Infecção Latente por Tuberculose? Realizou-se análise de conteúdo pela técnica do Discurso do Sujeito Coletivo. Resultados: Agrupamento dos discursos coletivos: 1) experiência e supervisão de tratamento da ILTB para pessoas em situação de vulnerabilidade; 2) cuidados familiares e a importância da Estratégia Saúde da Família no tratamento da ILTB; 3) campanhas de prevenção da ILTB; e 4) fragilidade na integração com serviços especializados e ausência de fluxos assistenciais/linha de cuidado. Conclusão: As ideias do discurso coletivo expressam a necessidade de mudanças na gestão do trabalho em saúde no nível de atenção primária, a fim de potencializar as ações de prevenção e tratamento existentes, considerando a educação permanente, a definição de fluxos assistenciais e de linhas de cuidado, com destaque para a população em situação de vulnerabilidade.

Objective: To analyze the perception and experiences of Primary Health Care professionals regarding the prevention of Latent Tuberculosis Infection (LTBI). Material and Method: Exploratory, descriptive study, with a qualitative approach, carried out with eight primary care health professionals, from three states of Brazil (midwest, southeast and south) and the Federal District. Data were collected through a semi-structured collective interview with the guiding question: What is the perception and experience of primary health care professionals in preventing Latent Tuberculosis Infection? Content analysis was performed using the Collective Subject Discourse technique. Results: Grouping of collective discourses: 1) experience and supervision of LTBI treatment for vulnerable people; 2) Family care and the importance of the Family Health Strategy in the treatment of LTBI; 3) LTBI prevention campaigns and 4) fragility in integration with specialized services and absence of care flows/line of care. Conclusion: The ideas of the collective discourse express the need for changes in the management of health work at the primary care level, in order to enhance existing prevention and treatment actions, considering permanent education, the definition of assistance flows and lines of care, with emphasis on the vulnerable population.

Objetivo: Analizar la percepción y experiencia de los profesionales de la Atención Primaria en Salud sobre la prevención de la Infección de Tuberculosis Latente. Material y Método: Estudio exploratorio, descriptivo, de abordaje cualitativo, realizado con ocho profesionales de salud de la atención primaria, de tres estados de Brasil (centro-oeste, sureste y sur) y del Distrito Federal. Los datos fueron recolectados a través de una entrevista colectiva semiestructurada con la pregunta orientadora: ¿Cuál es la percepción y experiencia de los profesionales de salud de la atención primaria para la prevención de la Infección de Tuberculosis Latente? Se realizó el análisis de contenido mediante la técnica del Discurso del Sujeto Colectivo. Resultados: Agrupación de los discursos colectivos: 1) experiencia y supervisión del tratamiento de la tuberculosis latente para personas vulnerables; 2) Cuidados de la familia y la importancia de la Estrategia de Salud Familiar en el tratamiento de la tuberculosis latente; 3) campañas de prevención de infección de tuberculosis latente y 4) fragilidad para la integración con los servicios especializados y ausencia de líneas de cuidado. Conclusión: El discurso colectivo expresa la necesidad de cambios en la gestión del trabajo en salud en la atención primaria para potenciar acciones de prevención y tratamiento existentes, teniendo en consideración la educación permanente, la definición de líneas asistenciales y de cuidados, con énfasis en la población vulnerable.

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

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

Completude do sistema de informação de agravos de notificação compulsória de gestante hiv positivo entre 2001 e 2006, no Espírito Santo, Brasil / Completeness of information system for agravos for notification of pregnancy compulsória hiv positive between 2001 and 2006, in the Espirito Santo, Brazil

O objetivo foi analisar a completude dos campos das investigaçõesda base de dados de gestante Vírus da Imunodeficiência Humana(HIV) positivoe criança exposta do Sistema de Informação de Agravos de NotificaçãoCompulsória (SINAN), no Espírito Santo, entre 2001 a 2006. Estudo descritivo,retrospectivo, com utilização de dados secundários. Para avaliar a completude,foram utilizados os parâmetros: excelente (maior que 90%), regular (entre 70%e 89%) e ruim (abaixo de 70%). Calculou-se a média de completude de 34 variáveis,utilizando-se a base nacional do SINAN. As variáveis analisadas foramsubdivididas em blocos: informação da notificação; informação da mãe; AIDSna gravidez; informação da criança; aleitamento; histórico da criança; dados laboratoriaise acompanhamento. As variáveis raça/cor e escolaridade apresentaramcompletude excelente no Estado. Dentre os fatores que contribuem para aredução da transmissão vertical do HIV, as variáveis evolução da gravidez, inícioda profilaxia no recém-nascido e aleitamento materno foram classificadas comoregular, enquanto o aleitamento cruzado foi considerado ruim. As informaçõesreferentes à criança exposta ao vírus foram as que apresentaram menor grau depreenchimento. Conclui-se que dados relativos à prevenção da TV estão incompletos.A notificação, por ser realizada na maioria das vezes no período gestacional,apresenta falhas nas informações referentes à criança. Há necessidade demaiores esclarecimentos aos profissionais de saúde sobre a importância do preenchimentodos campos, para que seja possível traçar estratégias para prevençãoe controle da TV no Espírito Santo.

The objective was to analyze thecompleteness of the s of investigations ofthe database of HIV positive pregnant womenand children exposed to the Information SystemDiseases Notification Compulsória (SINAN),in the Espirito Santo, from 2001 to 2006. Descriptivestudy, retrospective, the use of secondarydata. To evaluate the completeness were usedthese parameters: excellent (greater than 90%),regular (between 70% and 89%) and poor (below70%) calculated the mean of completion of 34variables, using the base ?s national SINAN.The variables examined were divided into blocks:information of the notification; information of themother; AIDS in pregnancy; information of thechild; lactation; history of the child; laboratorydata and monitoring. Variables race / color andcompleteness showed excellent schooling in the state.Among the factors that contribute to the reductionof vertical transmission of HIV, the variablesevolution of pregnancy, initiation of prophylaxisin newborns and breastfeeding were classified asregular, while breastfeeding cross was consideredbad. Information regarding child exposed to thevirus were those who had lower degree of filling.It is concluded that data on the prevention of TVare incomplete. The notification to be performedmost often in the gestational period shows flaws inthe information concerning the child. There is needfor further clarification to health care professionalson the importance of filling in the s, in orderto draw strategies for prevention and control of theTV in the Holy Spirit.