Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.584
Cochrane Database Syst Rev ; 12: CD012918, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31828771


BACKGROUND: Tuberculosis causes more deaths than any other infectious disease worldwide, with pulmonary tuberculosis being the most common form. Standard first-line treatment for drug-sensitive pulmonary tuberculosis for six months comprises isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) for two months, followed by HRE (in areas of high TB drug resistance) or HR, given over a four-month continuation phase. Many people do not complete this full course. Shortened treatment regimens that are equally effective and safe could improve treatment success. OBJECTIVES: To evaluate the efficacy and safety of shortened treatment regimens versus the standard six-month treatment regimen for individuals with drug-sensitive pulmonary tuberculosis. SEARCH METHODS: We searched the following databases up to 10 July 2019: the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE (PubMed); Embase; the Latin American Caribbean Health Sciences Literature (LILACS); Science Citation Index-Expanded; Indian Medlars Center; and the South Asian Database of Controlled Clinical Trials. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform,, the Clinical Trials Unit of the International Union Against Tuberculosis and Lung Disease, the UK Medical Research Council Clinical Trials Unit, and the Clinical Trials Registry India for ongoing trials. We checked the reference lists of identified articles to find additional relevant studies. SELECTION CRITERIA: We searched for randomized controlled trials (RCTs) or quasi-RCTs that compared shorter-duration regimens (less than six months) versus the standard six-month regimen for people of all ages, irrespective of HIV status, who were newly diagnosed with pulmonary tuberculosis by positive sputum culture or GeneXpert, and with presumed or proven drug-sensitive tuberculosis. The primary outcome of interest was relapse within two years of completion of anti-tuberculosis treatment (ATT). DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, extracted data, and assessed risk of bias for the included trials. For dichotomous outcomes, we used risk ratios (RRs) with 95% confidence intervals (CIs). When appropriate, we pooled data from the included trials in meta-analyses. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: We included five randomized trials that compared fluoroquinolone-containing four-month ATT regimens versus standard six-month ATT regimens and recruited 5825 adults with newly diagnosed drug-sensitive pulmonary tuberculosis from 14 countries with high tuberculosis transmission in Asia, Africa, and Latin Ameria. Three were multi-country trials that included a total of 572 HIV-positive people. These trials excluded children, pregnant or lactating women, people with serious comorbid conditions, and those with diabetes mellitus. Four trials had multiple treatment arms. Moxifloxacin replaced ethambutol in standard four-month, daily or thrice-weekly ATT regimens in two trials; moxifloxacin replaced isoniazid in four-month ATT regimens in two trials, was given daily in one trial, and was given with rifapentine instead of rifampicin daily for two months and twice weekly for two months in one trial. Moxifloxacin was added to standard ATT drugs for three to four months in one ongoing trial that reported interim results. Gatifloxacin replaced ethambutol in standard ATT regimens given daily or thrice weekly for four months in two trials. Follow-up ranged from 12 months to 24 months after treatment completion for the majority of participants. Moxifloxacin-containing four-month ATT regimens Moxifloxacin-containing four-month ATT regimens that replaced ethambutol or isoniazid probably increased the proportions who experienced relapse after successful treatment compared to standard ATT regimens (RR 3.56, 95% CI 2.37 to 5.37; 2265 participants, 3 trials; moderate-certainty evidence). For death from any cause, there was probably little or no difference between the two regimens (2760 participants, 3 trials; moderate-certainty evidence). Treatment failure was rare, and there was probably little or no difference in proportions with treatment failure between ATT regimens (2282 participants, 3 trials; moderate-certainty evidence). None of the participants given moxifloxacin-containing regimens developed resistance to rifampicin, and these regimens may not increase the risk of acquired resistance (2282 participants, 3 trials; low-certainty evidence). Severe adverse events were probably little or no different with moxifloxacin-containing four-month regimens that replaced ethambutol or isoniazid, and with three- to four-month regimens that augmented standard ATT with moxifloxacin, when compared to standard six-month ATT regimens (3548 participants, 4 trials; moderate-certainty evidence). Gatifloxacin-containing four-month ATT regimens Gatifloxacin-containing four-month ATT regimens that replaced ethambutol probably increased relapse compared to standard six-month ATT regimens in adults with drug-sensitive pulmonary tuberculosis (RR 2.11, 95% CI 1.56 to 2.84; 1633 participants, 2 trials; moderate-certainty evidence). The four-month regimen probably made little or no difference in death compared to the six-month regimen (1886 participants, 2 trials; moderate-certainty evidence). Treatment failure was uncommon and was probably little or no different between the four-month and six-month regimens (1657 participants, 2 trials; moderate-certainty evidence). Acquired resistance to isoniazid or rifampicin was not detected in those given the gatifloxacin-containing shortened ATT regimen, but we are uncertain whether acquired drug resistance is any different in the four- and six-month regimens (429 participants, 1 trial; very low-certainty evidence). Serious adverse events were probably no different with either regimen (1993 participants, 2 trials; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Evidence to date does not support the use of shortened ATT regimens in adults with newly diagnosed drug-sensitive pulmonary tuberculosis. Four-month ATT regimens that replace ethambutol with moxifloxacin or gatifloxacin, or isoniazid with moxifloxacin, increase relapse substantially compared to standard six-month ATT regimens, although treatment success and serious adverse events are little or no different. The results of six large ongoing trials will help inform decisions on whether shortened ATT regimens can replace standard six-month ATT regimens. 9 December 2019 Up to date All studies incorporated from most recent search All eligible published studies found in the last search (10 Jul, 2019) were included.

Antituberculosos/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Protocolos Clínicos , Esquema de Medicação , Combinação de Medicamentos , Quimioterapia Combinada/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
Indian J Tuberc ; 66(4): 507-515, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31813442


To achieve the targets and milestones set by the World Health Organization (3) to their 'End TB Strategy' to stop the global TB epidemic by 2035 and India's commitment to eliminate this disease from the country by 2025 (4), it will be important to improve the case finding and effectively treat cases of tuberculosis both in the public and the private sector, the latter still holding a major share. To strengthen the management of tuberculosis in the private sector and to have uniformity in the treatment, we need to have a protocol, suitable to our socio-economic conditions, which will not only provide guidance in getting better treatment outcomes, but also help to interrupt transmission of the disease in the community, besides curbing the development of drug resistance. Several guidelines on the management of tuberculosis are available, but these are considered as very good starting points for treatment but not the only treatment option, since guidelines cannot address every possible situation and substitute for good clinical judgment (5).Hence to meet these requirements and shortcomings following protocol is provided to manage cases of tuberculosis and resolve several issues related to it.

Antituberculosos/uso terapêutico , Guias de Prática Clínica como Assunto , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Antituberculosos/administração & dosagem , Terapia Diretamente Observada , Humanos , Índia
Indian J Tuberc ; 66(4): 520-532, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31813444


BACKGROUND: Treatment of drug susceptible tuberculosis (DS-TB) requires regimens containing first line drugs (FLDs') whereas drug resistant tuberculosis (DR-TB) are treated with regimens comprising combination of both second line drugs (SLDs') and few FLDs'. Adverse drug reactions (ADRs') to these anti-tubercular drugs are quite common as they are being used for longer duration. ADRs' may cause associated morbidity and even mortality if not recognized early. There are major concerns regarding treatment of DR-TB patients particularly with SLDs' in that they are expensive, have low efficacy and more toxic as compared to FLDs'. There may be a severe impact on adherence and higher risk of default and treatment failure affecting outcome overall if such ADRs' are not properly managed. METHODS: A search strategy was adopted involving principal electronic databases (Pubmed, EMBASE, Google and Google scholar) of English language articles from 1990 till now, using various terms in combination. All articles with resulting titles, abstract and full text, when available were read and kept for reference. RESULTS: 101 articles including 4 systematic reviews have been identified. The overall prevalence of ADRs' with FLDs' and SLDs' are estimated to vary from 8.0% to 85% and 69% to 96% respectively. Most ADRs' are observed in the intensive phase as compared to continuation phase. No difference in frequency of ADRs' was reported with intermittent or daily intake of anti-tubercular drugs. The occurrence of ADRs' may be influenced by multiple factors and may range from mild gastrointestinal disturbances to serious hepatotoxicity, ototoxicity, nephrotoxicity peripheral neuropathy, cutaneous ADRs', etc. Most of ADRs' are minor and can be managed without discontinuation of treatment. Some ADRs' can be major or severe causing life-threatening experience leading to either modification or discontinuation of regimen and even mortality if not recognized and treated promptly. CONCLUSION: Early recognition by active surveillance and appropriate management of these ADRs' might improve adherence and treatment success.

Antituberculosos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Humanos
PLoS Med ; 16(12): e1002884, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31821323


Andrew Vernon and co-authors discuss adherence to therapy and its measurement in tuberculosis treatment trials.

Ensaios Clínicos como Assunto , Projetos de Pesquisa , Tuberculose/terapia , Humanos
Int J Mycobacteriol ; 8(4): 313-319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31793499


Background: Despite effort to diagnose tuberculosis (TB) in the Human Immunodeficiency Virus (HIV) infected population, 45% of adults with HIV that had a previously unknown reason for death, demonstrated TB was the cause by autopsy examination. We aimed to assess the clinical outcomes of implementation a new algorithm for diagnosis and treatment of tuberculosis (TB) related sepsis among PLHIV presenting with life-threatening illness. Methods: This study is a prospective cohort conducted in three-referral hospitals in Kilimanjaro, recruited 97 PLHIV from February through June 2018. Patients provided urine and sputum samples for testing lateral flow - lipoarabinomannan (LF-LAM) and Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assays, respectively. Anti-TB was prescribed to patients with positive LF-LAM or Xpert MTB/RIF or received broad-spectrum antibiotics but deteriorated. Results: Of 97 patients, 84 (87%) provided urine and sputa, and 13 (13%) provided only urine. The mean age (95% confidence interval) was 40 (38-43) years and 52 (54%) were female. In 84 patients, LF-LAM increased TB detection from 26 (31%) by Xpert MTB/RIF to 41 (55%) by both tests. Of 97 patients, 69 (71%) prescribed anti-TB, 67% (46/69) and 33% (23/69) had definitive and probable TB respectively. Sixteen (16.5%) patients died, of which one died before treatment, 73% (11/15) died within 7 days of admission. The 30-day survival was similar in both treatment groups (log rank = 0.1574). Mortality was significantly higher among hospitalized patients compared to outpatients (P ≤ 0.027). Conclusion: Implementation of new algorithm increased TB case detection in patients that could have been missed by Xpert MTB/RIF assay. Survival of PLHIV with confirmed or probable TB was comparable to those of PLHIV that were treated with broad-spectrum antibiotics alone. Further work should focus on the optimal timing and content of the immediate antimicrobial regimen for sepsis among PLHIV in TB-endemic settings.

Algoritmos , Infecções por HIV/complicações , Sepse/diagnóstico , Sepse/tratamento farmacológico , Tuberculose/complicações , Tuberculose/diagnóstico , Adulto , Feminino , Implementação de Plano de Saúde , Humanos , Lipopolissacarídeos/urina , Masculino , Estudos Prospectivos , Sepse/microbiologia , Resultado do Tratamento , Tuberculose/sangue , Tuberculose/urina
BMC Public Health ; 19(1): 1598, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783742


BACKGROUND: The identification and treatment of LTBI is a key component of the WHO's strategy to eliminate TB. Recent migrants from high TB-incidence countries are recognised to be at risk TB reactivation, and many high-income countries have focused on LTBI screening and treatment programmes for this group. However, migrants are the group least likely to complete the LTBI cascade-of-care. This pragmatic cluster-randomised, parallel group, superiority trial investigates whether a model of care based entirely within a community setting (primary care) will improve treatment completion compared with treatment in specialist TB services (secondary care). METHODS: The CATAPuLT trial (Completion and Acceptability of Treatment Across Primary Care and the community for Latent Tuberculosis) randomised 34 general practices in London, England, to evaluate the efficacy and safety of treatment for LBTI in recent migrants within primary care. GP practices were randomised to either provide management for LTBI entirely within primary care (GPs and community pharmacists) or to refer patients to secondary care. The target recruitment number for individuals is 576. The primary outcome is treatment completion (defined as taking at least 90% of antibiotic doses). The secondary outcomes assess adherence, acceptance of treatment, the incidence of adverse effects including drug-induced liver injury, the rates of active TB, patient satisfaction and cost-effectiveness of LTBI treatment. This protocol adheres to the SPIRIT Checklist. DISCUSSION: The CATAPuLT trial seeks to provide implementation research evidence for a patient-centred intervention to improve treatment completion for LTBI amongst recent migrants to the UK. TRIAL REGISTRATION: NCT03069807, March 2017, registered retrospectively.

Tuberculose Latente/diagnóstico , Tuberculose Latente/tratamento farmacológico , Programas de Rastreamento/métodos , Atenção Primária à Saúde/métodos , Migrantes , Antituberculosos/economia , Antituberculosos/uso terapêutico , Análise por Conglomerados , Análise Custo-Benefício , Humanos , Tuberculose Latente/etnologia , Londres , Programas de Rastreamento/economia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
J Clin Tuberc Other Mycobact Dis ; 17: 100121, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31788563


Tuberculosis diagnosis and treatment currently revolves around clinical features and microbiology. The disease however adversely affects patients' psychological, economic, and social well-being as well, and therefore our focus also additionally needs to shift towards quality of life (QOL). The disease influences all QOL domains and substantially adds to patient morbidity, and these complex and multidimensional interactions pose challenges in accurately quantifying impairment in QOL. For this review, PubMed database was queried using keywords like quality of life, health status and tuberculosis, and additional publications identified by a bibliographic review of shortlisted articles. Both generic and specific QOL scales show a wide variety of derangements in scores, and results vary across countries and patient groups. In particular, diminished capacity to work, social stigmatization, and psychological issues worsen QOL in patients with tuberculosis. Although QOL has been consistently shown to improve during standard anti-tubercular therapy, many patients continue to show residual impairment. It is also not clear if specific situations like presence of comorbid illnesses, drug resistance, or co-infection with human immunodeficiency virus additionally worsen QOL in these patients. There is a definite need to incorporate QOL assessment as adjunct outcome measures in tuberculosis control programs. Governments and program managers need to step up socio-cultural reforms and health education, and provide additional incentives to patients, to counter impairment in QOL.

J Clin Tuberc Other Mycobact Dis ; 17: 100127, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31788569


Background: Tuberculosis affected 2.7 million people in India in 2017. The Revised National TB Control Programme has achieved milestones in coverage, however quality of TB care remains highly variable and often poor, with significant gaps in provider knowledge, practices, and patients consistently lost to follow-up. These quality gaps are largely informed by studies on provider practices or objective chart abstractions and case data. Per the knowledge of the author, no review has been conducted on first-hand patient perspectives on the quality of TB care they receive. This mixed-methods literature review aims to synthesize evidence on user-experience and patient satisfaction with TB care in India and inform areas for service quality improvement. Methods: Five medical databases, including PubMed, EMBASE, Global Health (Ovid), Web of Science, and CINAHL were searched for empirical studies on patient perspectives on TB health services published between January 1st, 2000 to December 31st, 2017. Studies in English with adult patients with any form of TB in the public or private health system were included. Studies prior to entering the health system, on distance to health facilities and cost were excluded. Seven Indian journals were hand searched and a grey literature search was conducted in GoogleScholar. Studies were assessed for methodological quality and thematic analysis was conducted by categorizing data using NVivo 12. Results: A total of 498 studies were screened, of which 23 met the inclusion criteria. 16 supplementary studies were identified from Indian journals and grey literature. Of the 39 total studies included most were quantitative (29; 74%), based in South India (17; 44%) and focused on drug-sensitive TB patients (19; 49%) within the public health system (25; 64%). Data collection methods were highly heterogenous which limited synthesis and comparisons across population demographics, health sectors, or regions. Overall quantitative patient satisfaction measured in seven studies was high. Two major themes identified were provider-related factors (n = 26 studies) and convenience (n = 25), and six minor themes were supplies and equipment availability (n = 12), confidence (n = 10), information and communication (n = 10), waiting time (n = 8), stigma (n = 4), and confidentiality (n = 4). Each reported positive and negative user-experiences. Most significantly, DOTS did not fit the daily needs and obligations of many patients, particularly due to conflicts with employment and frequency of visits; while positive provider support, information, and flexibility helped patients adhere to treatment. Conclusion: Although quantitative patient satisfaction was found to be high, data were not collected using robust, validated tools. Qualitative and quantitative user-experiences in each theme were variable, making them both barriers and facilitators of good quality TB care. Poor user-experiences were often responsible for patients interrupting treatment or dropping out of TB care. Patient-centeredness, or user-friendliness of TB care can be improved by introducing individualized or flexible DOTS that is responsive to user circumstances and needs. User-experience data should be systematically collected using a standardized, national tool for identification of specific bottlenecks and successes in quality of TB care from the patients' perspective.

Chin Med J (Engl) ; 132(24): 2950-2959, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31833904


BACKGROUND: Tuberculosis (TB) is one of the most debilitating diseases worldwide. Current studies have shown that vitamin D plays a significant role in host immune defense against Mycobacterium tuberculosis, but clinical trials reported inconsistent results. Therefore, we systematically reviewed the literature to investigate whether vitamin D supplementation could improve the effect of anti-TB therapy. METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from their inception to February 8th, 2019 for randomized controlled trials on vitamin D supplementation in patients with pulmonary TB receiving anti-TB therapy. The primary outcomes were time to sputum culture and smear conversion and proportion of participants with negative sputum culture. The secondary outcomes were clinical response to treatment and adverse events. A random-effects model was used to pool studies. Data were analyzed using RevMan 5.3 software. RESULTS: Five studies with a total of 1126 participants were included in our meta-analysis. Vitamin D supplementation did not shorten the time to sputum culture and smear conversion (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.89-1.23, P = 0.60; HR 1.15, 95% CI 0.93-1.41, P = 0.20, respectively) and did not lead to an increase in the proportion of participants with negative sputum culture (relative risk [RR] 1.04, 95% CI 0.97-1.11, P = 0.32). However, it reduced the time to sputum culture conversion in the sub-group of participants with TaqI tt genotype (HR 8.09, 95% CI 1.39-47.09, P = 0.02) and improved the multidrug-resistant (MDR) TB sputum culture conversion rate (RR 2.40, 95% CI 1.11-5.18, P = 0.03). There was no influence on secondary outcomes. CONCLUSIONS: Vitamin D supplementation had no beneficial effect on anti-TB treatment, but it reduced the time to sputum culture conversion in participants with tt genotype of the TaqI vitamin D receptor gene polymorphism and improved the MDR TB sputum culture conversion rate.

Rev Panam Salud Publica ; 43, December 2019
Artigo em Espanhol | PAHO-IRIS | ID: phr-51783


[RESUMEN]. Objetivo. Evaluar el control de la tuberculosis pulmonar en un centro de privación de la libertad e identificar los factores de riesgo asociados con tratamiento no exitoso en la cárcel más grande en Ecuador. Métodos. Se analizaron los datos de vigilancia de la prisión y de una cohorte de internos diagnosticados con tuberculosis (TB) entre los años 2015 y 2016. Se excluyeron los registros sin desenlace en el tratamiento. Se estimó el porcentaje de sintomáticos respiratorios (SR) identificados y la tasa de incidencia de TB. Los factores asociados con el tratamiento no exitoso se estimaron con regresión logística binomial. Resultados. De 59 846 consultas médicas, el 3% se identificó como SR y, de estos, 326 reclusos tenían TB, 184 fueron analizados. La tasa de incidencia de TB en la prisión fue de 3 947/100 000 habitantes. El porcentaje de tratamiento exitoso fue de 70,4% (65,6% curado y 4,8% con tratamiento completo) y 29,4% de tratamiento no exitoso (12,5% de pérdidas durante el seguimiento, 5% fallecieron, 1,1% de fracasos de tratamiento y 10,8% no fueron evaluados). La seropositividad para el virus de la inmunodeficiencia humana (VIH) se asoció con un mayor riesgo de tratamiento no exitoso (riesgo relativo: 1,66, intervalo de confianza de 95%: 1,33-2,07). Conclusión. La incidencia de TB en la prisión es 123 veces más alta que en la población general de Ecuador. Los prisioneros coinfectados con TB-VIH tienen mayor riesgo de no tener un tratamiento exitoso y se requiere articulación entre los ministerios de salud y de justicia que permita la implementación adecuada de protocolos de salud y de la Estrategia hacia el fin de la TB.

[ABSTRACT]. Objective. Evaluate the control of pulmonary tuberculosis in a detention center and identify the risk factors associated with unsuccessful treatment in the largest prison in Ecuador. Methods. Surveillance data from the prison and a cohort of inmates diagnosed with tuberculosis (TB) between 2015 and 2016 were analyzed. Records without treatment outcome information were excluded. The percentage of patients with respiratory symptoms and TB incidence rate were estimated. Factors associated with unsuccessful treatment were estimated with binomial logistic regression. Results. Of 59 846 medical consultations, 3% of respiratory symptoms were identified and, of these, 326 inmates had TB; 184 of them were analyzed. The incidence rate of TB in the prison was 3 947/100 000 inhabitants. Treatment was successful in 70.4% (65.6% cured; 4.8% treatment completed) and unsuccessful in 29.4% (12.5% lost during follow-up, 5% deceased, 1.1% treatment failure, 10.8% not evaluated). Seropositivity for human immunodeficiency virus (HIV) was associated with an increased risk of unsuccessful treatment (relative risk: 1.66, 95% confidence interval: 1.33-2.07). Conclusion. The incidence of TB in the prison was 123 times higher than in the general population of Ecuador. Prisoners co-infected with HIV-TB are at greater risk of not having a successful treatment, and articulation is required between the ministries of health and justice that allows the proper implementation of health protocols and the End TB Strategy.

[RESUMO]. Objetivo. Avaliar o controle da tuberculose (TB) pulmonar e identificar os fatores de risco associados ao tratamento malsucedido na maior prisão do Equador. Métodos. Foram analisados os dados de vigilância da prisão e de uma coorte de reclusos da mesma prisão, diagnosticados com TB em 2015 e 2016. Foram excluídos os registros sem resultado do tratamento. A porcentagem de sintomas respiratórios identificados e a taxa de incidência de TB foram estimadas. Os fatores associados ao tratamento malsucedido foram estimados com regressão logística binomial. Resultados. Em 59 846 consultas médicas, 3% dos reclusos foram identificadas com sintomas respiratórios. Entre esses, 326 tinham TB e 184 foram analisados. A taxa de incidência de TB na prisão foi de 3 947/100 000 habitantes. Observou-se tratamento bem-sucedido em 70,4% (65,6% curados e 4,8% com tratamento completo) e malsucedido em 29,4% (12,5% perdidos durante o acompanhamento, 5% morreram, 1,1% com falhas do tratamento e 10,8% sem avaliação). A soropositividade para HIV foi associada a risco aumentado de tratamento malsucedido (risco relativo 1,66; intervalo de confiança de 95%: 1,33 a 2,07). Conclusão A incidência de TB na prisão foi 123 vezes maior do que na população geral do Equador. Prisioneiros coinfectados com HIV-TB correm maior risco de não ter tratamento bem-sucedido. É necessária uma articulação entre os ministérios da saúde e da justiça para implementar de forma adequada os protocolos de saúde e da Estratégia pelo Fim da TB.

Tuberculose , Prisioneiros , Equador , Prisioneiros , Tuberculose , Prisioneiros
Rev Panam Salud Publica ; 43, December 2019
Artigo em Espanhol | PAHO-IRIS | ID: phr-51757


[RESUMEN]. Objetivo. Estimar la prevalencia nacional y regional de la comorbilidad tuberculosis (TB) y diabetes mellitus (DM) e identificar los factores asociados con esta comorbilidad en Paraguay. Métodos. Estudio transversal en pacientes con TB notificada en 2016 y 2017 y registrados en la base de datos del Programa Nacional de Control de la TB. La prevalencia de DM, definida por autonotificación, se estimó en pacientes con TB. Para conocer los factores asociados con la comorbilidad TB-DM se empleó un modelo multivariante de regresión binomial para ajustar las razones de prevalencia (RP) según los errores estándar por el clúster de región sanitaria. Resultados. Entre 2016 y 2017 se notificaron 5 315 casos de TB. La prevalencia de la comorbilidad TB-DM fue 6,3% en 2016, 6,0% en 2017 y 6,2% en ambos años. Fue más alta en Itapúa (9,2%), Alto Paraguay (8,0%), Alto Paraná (7,5%), Central (7,4%) y Asunción (7,2%). La mediana de edad de personas con DM fue más alta que la de las que no tenían DM (55 y 33 años; P < 0,001). Tener una edad mayor de 45 años (RP = 18,3), antecedente de hipertensión arterial (HTA) (RP = 2,17), baciloscopía de diagnóstico de tres cruces (RP 1,98), y antecedente de enfermedad pulmonar obstructiva crónica (EPOC) (RP 1,68) estuvieron asociados con mayor comorbilidad. En cambio, se asociaron con menor comorbilidad pertenecer a la población indígena (RP = 0,26), la infección por el virus de la inmunodeficiencia humana (RP = 0,44), historia de adicción a drogas (RP = 0,49), el sexo masculino (RP = 0,64), y la TB extrapulmonar (RP = 0,75). Conclusiones. La prevalencia de la comorbilidad de TB y DM en Paraguay, por autonotificación, fue 6,2% en el periodo 2016-2017 y varió entre las regiones sanitarias. La edad, el sexo, una alta carga bacilar al diagnóstico y la comorbilidad con HTA y EPOC se asociaron a una mayor comorbilidad. Estos hallazgos permitirán priorizar grupos de población para aumentar rendimiento del cribado, diagnóstico, tratamiento y prevención de la comorbilidad TB-DM en Paraguay.

[ABSTRACT]. Objective. To estimate the national and regional prevalence of tuberculosis (TB) and diabetes mellitus (DM) co-morbidity and identify the factors associated with this co-morbidity in Paraguay. Methods. Cross-sectional study in patients with TB notified in 2016 and 2017 and registered in the database of the National TB Control Program. The prevalence of self-reported DM was estimated in patients with TB. A multivariate binomial regression model was used to know the factors associated with TB-DM co-morbidity to adjust the prevalence ratios (PR) according to standard errors by health region. Results. Between 2016 and 2017, 5 315 cases of TB were reported. The prevalence of TB-DM co-morbidity was 6.3% in 2016, 6.0% in 2017, and 6.2% in both years. It was highest in Itapua (9.2%), Alto Paraguay (8.0%), Alto Parana (7.5%), Central (7.4%) and Asuncion (7.2%). The median age of people with DM was higher than that of those without DM (55 vs 33 years; P < 0.001). Being older than 45 years (RP = 18.3), history of hypertension (RP = 2.17), diagnostic baciloscopy +++ (RP 1.98), and history of chronic obstructive pulmonary disease (COPD) (RP 1.68) were associated with greater co-morbidity. A lower co-morbidity was associated with belonging to the indigenous population (RP = 0.26), human immunodeficiency virus infection (RP = 0.44), history of drug dependence (RP = 0.49), male sex (RP = 0.64), and extrapulmonary TB (RP = 0.75). Conclusions. The prevalence of self-reported co-morbidity of TB-DM in Paraguay was 6.2% in 2016-2017 and varied between health regions. Age, sex, high bacillary burden at diagnosis and co-morbidity with hypertension and COPD were associated with higher co-morbidity. These findings will allow prioritizing population groups to increase screening performance, diagnosis, treatment and prevention of TB-DM co-morbidity in Paraguay.

[RESUMO]. Objetivo. Estimar a prevalência nacional e regional de comorbidade entre tuberculose (TB) e diabetes mellitus (DM) no Paraguai e identificar os fatores associados a essa comorbidade. Métodos. Estudo transversal em pacientes com TB notificados em 2016 e 2017 e cadastrados na base de dados do Programa Nacional de Controle da TB. A prevalência de DM, definida por autorrelato, foi estimada em pacientes com TB. Para conhecer os fatores associados à comorbidade TB-DM, foi utilizado um modelo de regressão binomial multivariada para ajustar as razões de prevalência (RP) de acordo com os erros padrão do cluster da região de saúde. Resultados. Em 2016 e 2017 foram notificados 5 315 casos de TB. A prevalência de comorbidade TB-DM foi de 6,3% em 2016, 6,0% em 2017 e 6,2% para o período dos 2 anos. As prevalências mais altas foram observadas em Itapúa (9,2%), Alto Paraguai (8,0%), Alto Paraná (7,5%), Central (7,4%) e Assunção (7,2%). A mediana de idade foi mais alta em pessoas com DM do que naquelas sem DM (55 e 33 anos; P <0,001). Ter idade superior a 45 anos (RP = 18,3), história de hipertensão arterial (HAS) (RP = 2,17), baciloscopia diagnóstica (+++) (RP = 1,98) e história de doença pulmonar obstrutiva crônica (DPOC) (RP = 1,68) foram associados a maior comorbidade. Por sua vez, pertencer à população indígena (RP = 0,26), infecção pelo vírus da imunodeficiência humana (RP = 0,44), histórico de dependência de drogas (RP = 0,49), sexo masculino (RP = 0,64) e TB extrapulmonar (RP = 0,75) estiveram associados a menor comorbidade. Conclusões. A prevalência de comorbidade TB-DM no Paraguai, determinada a partir de autorrelato, foi de 6,2% no período 2016-2017 e variou entre as regiões de saúde. Idade, sexo, alta carga bacilar no diagnóstico e comorbidade com HAS e DPOC foram fatores associados a maior comorbidade. Esses achados permitirão priorizar grupos populacionais para aumentar o desempenho da triagem, diagnóstico, tratamento e prevenção da comorbidade TB-DM no Paraguai.

Tuberculose , Diabetes Mellitus , Comorbidade , Paraguai , Comorbidade , Tuberculose , Comorbidade , Paraguai
Rev Panam Salud Publica ; 43, December 2019
Artigo em Inglês | PAHO-IRIS | ID: phr-51756


[RESUMEN]. Objetivos. Estimar la carga de tuberculosis (TB) en menores de 15 años y describir las características clínico, epidemiológicas y los resultados del tratamiento antituberculoso en Ecuador. Métodos. Se realizó un estudio retrospectivo utilizando los datos del programa nacional de TB de los años 2015 y 2016. Se estimaron la tasa y el porcentaje de casos de TB infantil y se describieron las características de la enfermedad y el resultado del tratamiento según las categorías de edad: 0-4, 5-9 y 10-14 años. Resultados. De los 10 991 casos de TB diagnosticados, 223 (2,03%) fueron menores de 15 años; según la región del país esta carga varió entre 0 y 5,5%. De los 223 casos, en 213 se había registrado el resultado del tratamiento y fueron incluidos en el estudio; 78 (37%) eran menores de 5 años y en 147 (69%) no hubo registro de la investigación de contactos. Sesenta y cinco (68%) de los adolescentes y 40 (51%) de los menores de 5 años tenían diagnóstico de TB pulmonar. La prevalencia de VIH fue 11,5% en los menores 5 años y 6,3% en el grupo de 10-14 años. El tratamiento fue satisfactorio en el 93% de los casos, (curación, 36,6%, tratamiento terminado, 56,8%). Conclusiones: Ecuador presenta un alto porcentaje de subdiagnóstico de TB infantil y una carga menor a la esperada, principalmente en menores de 5 años. La alta prevalencia de VIH y la falta de sistematización adecuada de la investigación de contactos en los adolescentes revelan la necesidad de considerar estrategias centradas en la familia y que involucren la capacitación del personal de salud en el manejo del paciente pediátrico centrándose en las necesidades específicas de cada población.

[ABSTRACT]. Objectives. To estimate the tuberculosis (TB) burden in children under 15 years of age and to describe the clinical and epidemiological characteristics and the results of the anti-tuberculosis treatment in Ecuador. Methods. A retrospective study was carried out using data from the national TB programm for 2015 and 2016. The rate and percentage of cases of childhood TB were estimated and the disease characteristics and treatment outcome were described according to age categories: 0-4, 5-9 and 10-14 years. Results. Of the 10 991 cases of TB diagnosed, 223 (2.03%) were under 15 years of age; depending on the region, this burden ranged from 0 to 5.5%. Of the 223 cases, 213 had their treatment outcome registered and were included in the study; 78 (37%) were younger than 5 years and 147 (69%) had no record of contact screening. Sixty-five (68%) of the adolescents and 40 (51%) of the children under 5 had a diagnosis of pulmonary TB. HIV prevalence was 11.5% in children under 5 and 6.3% in the 10-14 age group. Treatment was succesful in 93% of cases (cure, 36.6%, treatment completed, 56.8%). Conclusions. Ecuador presents a high percentage of under-diagnosis of childhood TB and a lower than expected burden, mainly in children under 5 years of age. The high prevalence of HIV and the lack of adequate systematization of adolescent contact screening suggest the need to consider family-centered strategies that involve training health personnel in the management of pediatric patients, with a focus on the specific needs of each population

[RESUMO]. Objetivos. Estimar a carga de tuberculose (TB) em crianças menores de 15 anos e descrever as características clínicas e epidemiológicas e os resultados do tratamento antituberculose no Equador. Métodos. Foi realizado um estudo retrospectivo utilizando dados do programa nacional de TB para os anos de 2015 e 2016. A taxa e a porcentagem de casos de tuberculose infantil foram estimadas. As características da doença e o resultado do tratamento foram descritos de acordo com as categorias de idade: 0 a 4 anos, 5 a 9 anos e 10 a 14 anos. Resultados. Dos 10 991 casos de TB diagnosticados, 223 (2,03%) tinham menos de 15 anos. A carga de TB variou de 0 a 5,5%, dependendo da região do país. Em 213 dos 223 casos, o resultado do tratamento havia sido registrado, possibilitando a inclusão no estudo. Desses, 78 (37%) tinham menos de 5 anos; em 147 (69%) não havia registro da investigação de contato. Sessenta e cinco (68%) dos adolescentes e 40 (51%) dos menores de 5 anos foram diagnosticados com TB pulmonar. A prevalência de HIV foi de 11,5% em crianças menores de 5 anos e de 6,3% no grupo de 10 a 14 anos. O tratamento foi satisfatório em 93% dos casos (cura, 36,6%; tratamento concluído, 56,8%). Conclusões. O Equador tem uma elevada porcentagem de subdiagnóstico de TB infantil e a carga da doença ficou abaixo do esperado, principalmente em crianças menores de 5 anos. A alta prevalência do HIV e a falta de sistematização da pesquisa de contatos em adolescentes revelam a necessidade de considerar estratégias centradas na família, que envolvam o treinamento de profissionais de saúde no manejo do paciente pediátrico, com foco nas necessidades específicas de cada população.

Tuberculose , Resultado do Tratamento , Criança , Adolescente , Equador , Resultado do Tratamento , Criança , Adolescente , Tuberculose , Resultado do Tratamento , Crianças Órfãs
Rev Panam Salud Publica ; 43, December 2019
Artigo em Inglês | PAHO-IRIS | ID: phr-51755


[ABSTRACT]. Objective. To identify socio-demographic and clinical factors associated with mortality among persons with tuberculosis (TB) and TB/HIV co-infection in Suriname. Methods. This was a retrospective cohort study using data from the national TB and HIV databases for 2010 – 2015. The survival probability of TB and TB/HIV co-infected patients was analyzed using the Kaplan-Meier estimates and the log-rank test. A Cox proportional hazard model was applied. Results. The study showed that HIV-seropositivity (aHR: 2.08, 95%CI: 1.48 – 2.92) and older age (aHR: 5.84, 95%CI: 3.00 – 11.4) are statistically associated with higher mortality. For the TB/HIV co-infected patients, TB treatment (aHR: 0.43, 95%CI: 0.35 – 0.53) reduces the risk of death. Similarly, HIV treatment started (aHR: 0.15, 95%CI: 0.12 – 0.19) and delayed (aHR: 0.25, 95%CI: 0.13 – 0.47) result in less hazard for mortality; Directly-Observed Treatment (aOR: 0.16, 95%CI: 0.09 – 0.29) further reduces the risk. Conclusions. The Ministry of Health of Suriname should develop strategies for early case-finding in key populations, such as for HIV and TB in men 60 years of age and older. Implementation of Isoniazid Preventive Therapy for HIV should be pursued. Scaling up TB and HIV treatment, preferably through supervision, are essential to reducing the TB/HIV mortality.

[RESUMEN]. Objetivo. Identificar factores sociodemográficos y clínicos asociados con la mortalidad en personas con tuberculosis (TB) y VIH en Suriname. Métodos. Estudio de cohorte retrospectivo llevado a cabo con información de las bases de datos nacionales de TB y VIH para el período 2010-2015. Se analizó la probabilidad de supervivencia de los pacientes con TB y con coinfección TB/VIH mediante estimaciones de Kaplan-Meier y prueba de log-rank. Se aplicó un modelo de riesgo proporcional de Cox. Resultados. El estudio demostró que la seropositividad al VIH (cociente de riesgos instantáneos ajustado [aHR]: 2,08, IC 95%: 1,48-2,92) y la edad avanzada (aHR: 5,84, IC 95%: 3,00-11,4) están estadísticamente asociados con una mayor mortalidad. En los pacientes coinfectados con TB/VIH, el tratamiento de la TB (aHR: 0,43, IC 95%: 0,35-0,53) disminuye el riesgo de muerte. Del mismo modo, el inicio (dentro de 56 días) del tratamiento antirretroviral (aHR: 0,15, IC 95%: 0,12-0,19) y retrasado (aHR: 0,25, IC 95%: 0,13-0,47) conllevan un menor riesgo de mortalidad; el tratamiento directamente observado (aOR: 0,16, IC 95%: 0,09- 0,29) reduce aún más el riesgo. Conclusiones. El Ministerio de Salud de Suriname debe desarrollar estrategias para la búsqueda temprana de casos de TB y VIH en poblaciones clave, como en los varones de 60 años de edad o mayores. Debería establecerse el tratamiento preventivo con isoniazida en las personas con VIH. A fin de reducir la mortalidad debida a la TB y el VIH es esencial ampliar el tratamiento de ambas enfermedades, preferiblemente de manera supervisada.

[RESUMO]. Objetivo. Identificar fatores sociodemográficos e clínicos associados à mortalidade em pessoas com tuberculose (TB) e coinfecção pelo vírus da imunodeficiência humana (HIV) no Suriname. Métodos. Foi realizado um estudo de coorte retrospectivo. As informações foram obtidas das bases de dados nacionais de TB e HIV para o período de 2010 a 2015. A probabilidade de sobrevida dos pacientes com coinfecção por TB/HIV foi analisada a partir de estimativas de Kaplan-Meier e pelo teste log-rank. Um modelo de riscos proporcionais de Cox foi aplicado. Resultados. O estudo mostrou que soropositividade para o HIV (adjusted hazard ratio [aHR]: 2,08; IC95%: 1,48 a 2,92) e idade avançada (aHR: 5,84; IC95%: 3,00 a 11,4) foram estatisticamente associadas a maior mortalidade. Em pacientes coinfectados por TB e HIV, o tratamento da TB (aHR: 0,43; IC95%: 0,35 a 0,53) reduziu o risco de morte. Da mesma forma, o tratamento do HIV iniciado (em 56 dias) (aHR: 0,15; IC95%: 0,12 a 0,19) e retardado (aHR: 0,25; IC95%: 0,13 a 0,47) resultou em menor risco de mortalidade. O tratamento diretamente observado da tuberculose (aOR: 0,16; IC 95%: 0,09 a 0,29) reduziu ainda mais o risco. Conclusões. O Ministério da Saúde do Suriname deve desenvolver estratégias para a detecção precoce de casos em populações-chave, tais como homens com 60 anos de idade ou mais. A implementação da terapia preventiva com isoniazida para o HIV deve ser mantida. A intensificação do tratamento de TB e HIV, preferencialmente através da supervisão, é essencial para reduzir a mortalidade por TB/HIV.

Tuberculose , HIV , Mortalidade , Programas Nacionais de Saúde , Suriname , HIV , Mortalidade , Programas Nacionais de Saúde , Tuberculose , Mortalidade , Programas Nacionais de Saúde
Rev Panam Salud Publica ; 43, December 2019
Artigo em Inglês | PAHO-IRIS | ID: phr-51754


[EXTRACT]. Tuberculosis (TB) is a major source of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent, ranking above HIV/AIDS. TB is preventable, treatable, and curable. Timely diagnosis and treatment can cure most people who develop TB and curtail onward transmission (1). Treatment requires multiple drugs and requires from 6 months to 2 years depending on the type of TB (drug susceptible or resistant). These long, drug-treatment regimens are challenging for both patients and health care systems. The Sustainable Development Goals propose ending the TB epidemic by 2030 (2). The World Health Organization’s (WHO) End TB Strategy provides a framework for reaching this goal with a patient-centered approach and inter-programmatic and intersectoral interventions (3). These interventions involve affected communities and address the social determinants of TB, which have a greater impact on vulnerable populations. They are also aligned with the Universal Access to Health and Universal Health Coverage Strategy (4). The Declaration of the United Nations High-Level Meeting on TB held in September 2018 renewed the commitment of WHO Member States to strengthen their national TB efforts, fighting against this disease by leveraging the existing global frameworks (5, 6).

Tuberculose , Pesquisa , América
Rev Panam Salud Publica ; 43, December 2019
Artigo em Espanhol | PAHO-IRIS | ID: phr-51737


[RESUMEN]. Objetivo. Describir las características sociodemográficas y clínico-epidemiológicas y determinar los factores asociados a la mortalidad de personas con diagnóstico de tuberculosis en Paraguay. Métodos. Investigación operativa con un diseño de cohortes retrospectivo de los casos diagnosticados con TB en Paraguay entre 2015-2016. Se utilizó la base datos del Programa Nacional de Control de Tuberculosis. Para determinar los factores asociados con mortalidad se utilizaron pruebas chi cuadrado y riesgo relativo (RR) con un intervalo de confianza de 95% (IC95%); además, se ajustó un modelo de regresión múltiple de Poisson robusto. Se utilizó un nivel de significación de 5%. Resultados. Se estudiaron 5 141 casos de TB, de los cuales 11,5% fallecieron, los factores que aumentan el riesgo de muerte fueron: sexo masculino (RR: 1,26 IC; 95%: 1,1-1,50), infección con virus de la inmunodeficiencia humana (VIH) (RR: 4,78; IC 95%: 4,04-5,65) y enfermedad pulmonar obstructiva crónica (RR: 1,70; IC 95%: 1,19-2,42). Como factor protector se identificó ser persona privada de la libertad (RR: 0,37 IC 95%: 0,24-0,61). Conclusiones. El mayor riesgo de muerte lo presentan los hombres y las personas con coinfección TB/VIH y el menor riesgo, las personas privadas de la libertad. Es necesario mejorar el diagnóstico y seguimiento a los casos de TB, con la efectiva implementación del tratamiento directamente observado (TDO) así como el manejo oportuno de enfermedades asociadas como VIH y enfermedad pulmonar obstructica crónica (EPOC).

[ABSTRACT]. Objective. To describe the socio-demographic and clinical-epidemiological characteristics and to determine the factors associated with the mortality of people diagnosed with tuberculosis (TB) in Paraguay. Methods. Operational research with a retrospective cohort design of cases diagnosed with TB in Paraguay between 2015-2016. The database of the National Tuberculosis Control Program was used. Chi-square and relative risk (RR) tests with a 95% confidence interval (95% CI) were used to determine the factors associated with mortality; in addition, a robust Poisson multiple regression model was adjusted. A significance level of 5% was used. Results. Five hundred and forty-one cases of TB were studied, of which 11.5% died. The factors increasing the risk of death were male sex (RR 1.26; 95% CI 1.1-1.50), infection with human immunodeficiency virus (RR 4.78; 95% CI 4.04-5.65) and chronic obstructive pulmonary disease (RR 1.70; 95% CI 1.19-2.42). Being deprived of one’s liberty was a protective factor (RR 0.37; 95% CI 0.24-0.61). Conclusions. The highest risk of death is presented by men and people with TB/HIV coinfection and the lowest risk is presented by people deprived of liberty. There is a need to improve diagnosis and follow-up of TB cases, with effective implementation of directly observed treatment (DOTS) and timely management of associated diseases such as HIV and chronic obstructive pulmonary disease.

[RESUMO]. Objetivo. Descrever as características sociodemográficas e clínico-epidemiológicas e determinar os fatores associados à mortalidade de pessoas diagnosticadas com tuberculose (TB) no Paraguai. Métodos. Pesquisa operacional com desenho de coorte retrospectivo de casos diagnosticados com TB no Paraguai entre 2015-2016. Foi utilizada a base de dados do Programa Nacional de Controle da Tuberculose. Testes de qui-quadrado e risco relativo (RR) com intervalo de confiança de 95% (IC95%) foram utilizados para determinar os fatores associados à mortalidade; além disso, um robusto modelo de regressão múltipla de Poisson foi ajustado. Foi utilizado nível de significância de 5%. Resultados. Foram estudados quinhentos e quarenta e um casos de TB, dos quais 11,5% morreram. Os fatores que aumentaram o risco de morte foram sexo masculino (RR 1,26; IC95% 1,1-1,50), infecção por vírus da imunodeficiência humana (RR 4,78; IC95% 4,04-5,65) e doença pulmonar obstrutiva crônica (RR 1,70; 95 % CI 1,19-2,42). Ser privado de liberdade foi um fator protetor (RR 0,37; IC 95% 0,24-0,61). Conclusões O maior risco de morte é apresentado por homens e pessoas com co-infecção TB / HIV e o menor risco é apresentado por pessoas privadas de liberdade. É necessário melhorar o diagnóstico e o acompanhamento dos casos de TB, com a implementação efetiva do tratamento diretamente observado (DOTS) e o gerenciamento oportuno de doenças associadas, como o HIV e a doença pulmonar obstrutiva crônica.

Mortalidade , Tuberculose , Pesquisa Operacional , Paraguai , Mortalidade , Pesquisa Operacional , Mortalidade , Tuberculose , Pesquisa Operacional , Paraguai
Rev Panam Salud Publica ; 43, December 2019
Artigo em Espanhol | PAHO-IRIS | ID: phr-51736


[RESUMEN]. Objetivo. Conocer el porcentaje de cumplimiento de la terapia preventiva con isoniacida (TPI) en los establecimientos de salud de Quito, Ecuador y sus factores asociados en los niños menores de 5 años. Métodos. Investigación operativa con diseño de cohorte, en la que se obtuvo datos de informes y tarjetas de administración de tratamiento de los niños en TPI de los años 2014 al 2016 y de encuestas ad hoc aplicadas a cuidadores de los niños que recibieron TPI durante el año 2018. Resultados. Los niños menores de 5 años correspondieron a 29,3% del total de los contactos de los casos índices; 73% cumplieron TPI y 88,9% completaron al menos 6 meses de terapia. Se encontró asociación con la carga bacilar del caso índice, con la condición de pertenecer a un determinado distrito y su año de inicio. Se realizaron encuestas a 9 personas, funcionarios de los establecimientos salud y a 9 tutores de los niños; se registraron respuestas diversas sobre el agente causal de la tuberculosis, su transmisión y las características de la terapia preventiva. Conclusiones. La mayoría de los niños menores de 5 años que iniciaron TPI cumplieron con al menos 80% de las dosis prescritas, con determinadas asociaciones y percepciones en los cuidadores. En este contexto, surge la necesidad de realizar nuevas investigaciones operativas, para indagar más ampliamente sobre la adherencia y sobre los conocimientos, actitudes y prácticas de los profesionales de salud, los afectados por tuberculosis y su entorno.

[ABSTRACT]. Objective. Determine the percentage of children under 5 years of age who completed isoniazid preventive therapy (IPT) in health facilities in Quito, Ecuador, and assess related factors. Methods. Operations research with cohort design. Data were obtained from treatment reports on children in IPT between 2014 and 2016, and from ad hoc surveys of caregivers of children who received IPT in 2018. Results. Children under 5 represented 29.3% of all contacts of index cases; 73% completed IPT and 88.9% had at least six months of therapy. Associations were found with the bacterial load of the index case, with living in a given district, and with the year in which treatment was initiated. Surveys were conducted with nine staff members of health facilities and nine caregivers of children; diverse responses were given regarding the causative agent of tuberculosis, its transmission, and the characteristics of preventive therapy. Conclusions. The majority of children under 5 years of age who initiated IPT completed at least 80% of the prescribed doses, with varying associations and knowledge on the part of their caregivers. In this context, there is a need for further operations research in order to learn more about adherence and about the knowledge, attitudes, and practices of health professionals and those affected by tuberculosis, and their environment.

[RESUMO]. Objetivo. Conhecer a porcentagem de adesão à terapia preventiva com isoniazida (TPI) nas unidades de saúde de Quito, Equador, e os fatores associados à adesão em crianças com menos de 5 anos de idade. Métodos. Pesquisa operacional com desenho de coorte, na qual foram obtidos dados de relatórios e dos cartões de administração de TPI em crianças entre 2014 e 2016, bem como de questionários ad hoc aplicados aos cuidadores das crianças que receberam TPI durante o ano de 2018. Resultados. As crianças com menos de 5 anos de idade representaram 29,3% do total dos contatos dos casos índices; 73% aderiram à TPI e 88,9% completaram pelo menos 6 meses de tratamento. Identificamos associações com a carga bacilar do caso índice, com o distrito de residência do paciente e com o ano de início. Realizamos inquéritos com 9 funcionários das unidades de saúde e com 9 responsáveis pelas crianças, registrando respostas variadas sobre o agente causal da tuberculose, sua transmissão e as características da terapia preventiva. Conclusões. Em sua maioria, as crianças com menos de 5 anos de idade que iniciaram a TPI aderiram a pelo menos 80% das doses prescritas, havendo associações com certos fatores e com os conhecimentos dos cuidadores. Neste contexto, fica clara a necessidade de realizar novos estudos operacionais para compreender melhor a adesão ao tratamento e os conhecimentos, atitudes e práticas dos profissionais da saúde, dos afetados pela tuberculose e das pessoas em seu entorno.

Tuberculose , Isoniazida , Pesquisa Operacional , Equador , Isoniazida , Pesquisa Operacional , Tuberculose , Isoniazida , Pesquisa Operacional
Rev Panam Salud Publica ; 43, December 2019
Artigo em Espanhol | PAHO-IRIS | ID: phr-51735


[RESUMEN]. Objetivo. Determinar la incidencia de pérdida en el seguimiento (PEES) en pacientes tratados por tuberculosis (TB) resistente a rifampicina o multidrogorresistente (TB-RR/MDR) y los factores asociados a esta condición de egreso en Ecuador. Métodos. Estudio de cohorte retrospectivo de pacientes con TB-RR/MDR tratados con el esquema de 18 a 24 meses de la Organización Mundial de la Salud en 2014 y 2015 notificados al Ministerio de Salud del Ecuador. Se determinó la incidencia de PEES y se compararon las características clínicas y epidemiológicas de los casos egresados como PEES versus los egresados como éxito de tratamiento. Se analizó la sobrevida con regresión de Cox para evaluar factores asociados a PEES. Resultados. De 328 casos, 270 (82,3%) fueron analizados porque tuvieron condición de egreso notificada. El egreso como PEES fue 39,6% y el éxito de tratamiento 50,4%. Los factores de riesgo asociados a PEES fueron: antecedente de egreso como PEES en episodio previo de TB, cociente de riesgos instantáneos (HR, por sus siglas en inglés): 2,96 (1,53-5,73), P < 0,001; adicción al alcohol o drogas, HR: 2,82 (1,10-7,23), P = 0,031 y tener diagnóstico por la prueba Xpert® (TB-RR), HR: 1,53 (1,0-2,35), P = 0,048. Del total de PEES, 43% ocurrió después de nueve meses de tratamiento. Conclusión. La incidencia de PEES en pacientes con TB-RR/MDR en Ecuador está por encima del promedio en la Región de las Américas. Los tres factores identificados refuerzan la implementación de regímenes acortados y atención centrada en el paciente, siguiendo la Estrategia Fin a la Tuberculosis.

[ABSTRACT]. Objective. Determine the incidence of loss to follow-up (LTFU) in patients treated for rifampicin-resistant tuberculosis (RR-TB) or multidrug-resistant tuberculosis (RR/MDR-TB), and the factors associated with this discharge status in Ecuador. Methods. Retrospective cohort study of patients with RR/MDR-TB who followed the World Health Organization’s 18-24-month treatment regimen in 2014 and 2015, as reported by the Ministry of Health of Ecuador. The incidence of LTFU was determined, and clinical and epidemiological manifestations of cases discharged as LTFU were compared with those discharged as successfully treated. Survival was analyzed with Cox regression in order to evaluate factors associated with LTFU. Results. Of 328 cases, 270 (82.3%) were analyzed because they had a reported discharge status. Discharge as LTFU accounted for 39.6% of cases, and as successfully treated, 50.4%. The risk factors associated with LTFU were: previous discharge as LTFU in a previous TB episode [hazard ratio (HR): 2.96 (1.53-5.73), P < 0.001]; addiction to alcohol or drugs [HR: 2.82 (1.10-7.23), P = 0.031]; and having an Xpert® diagnosis (TBRR) [HR: 1.53 (1.0-2.35), P = 0.048]. Of the total LTFU, 43% occurred after nine months of treatment. Conclusion. The incidence of LTFU in patients with RR/MDR-TB in Ecuador is above the average for the Region of the Americas. The three identified factors support implementation of shorter regimens and patient-centered care, in line with the End TB Strategy.

[RESUMO]. Objetivo. Determinar o percentual de perda de seguimento de pacientes tratados para tuberculose resistente à rifampicina (TB-RR) ou tuberculose multirresistente a medicamentos (TB-MR) e os fatores associados à interrupção do tratamento no Equador. Métodos. Estudo de coorte retrospectivo de casos de pacientes com TB-RR/TB-MR tratados em 2014 e 2015 com o esquema farmacológico de 18 a 24 meses de duração da Organização Mundial da Saúde (OMS) que foram notificados ao Ministério da Saúde do Equador. Foi determinado o percentual de perda de seguimento e foram comparadas as características clínicas e epidemiológicas dos casos de interrupção do tratamento por perda de seguimento e daqueles com alta por sucesso no tratamento. Uma análise da sobrevida com o modelo de regressão de Cox foi realizada para avaliar os fatores associados à perda de seguimento. Resultados. De 328 casos registrados, 270 (82,3%) foram incluídos na análise por terem tido sua interrupção ou alta notificadas. Houve interrupção por perda de seguimento em 39,6% dos casos e alta por sucesso no tratamento em 50,4%. Os fatores de risco associados à perda de seguimento foram: história de perda de seguimento em tratamento anterior de TB, razão de riscos (hazard ratio, HR) 2,96 (1,53–5,73, P < 0,001); consumo excessivo de álcool ou drogas, HR 2,82 (1,10–7,23, P = 0,031); e diagnóstico de tuberculose pelo teste Xpert® (TB-RR), HR 1,53 (1,0–2,35, P = 0,048). A perda de seguimento ocorreu após nove meses de tratamento em 43% dos casos. Conclusão. O percentual de perda de seguimento de pacientes com TB-RR/TB-MR no Equador está acima da média da Região das Américas. Os três fatores identificados no estudo reforçam ser necessário implementar esquemas de tratamento mais curtos e prestar atenção centrada no paciente, segundo as recomendações da Estratégia pelo Fim da Tuberculose.

Perda de Seguimento , Tratamento de Emergência , Pesquisa Operacional , Equador , Tuberculose Resistente a Múltiplos Medicamentos , Perda de Seguimento , Terapêutica , Pesquisa Operacional , Tuberculose Resistente a Múltiplos Medicamentos , Terapêutica , Pesquisa Operacional
BMJ Open ; 9(12): e032760, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31852704


INTRODUCTION: Compared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6 months and longer when disease is drug resistant. If patients miss too many doses (non-adherence), they may transmit infection for longer and the infecting bacteria may develop resistance to the standard drugs used for treatment. Non-adherence may therefore risk both their health and that of others. Within England, certain population groups are thought to be at higher risk of non-adherence, but the factors contributing to this have been insufficiently determined, as have the best interventions to promote adherence. The objective of this study was to develop a manualised package of interventions for use as part of routine care within National Health Services to address the social and cultural factors that lead to poor adherence to treatment for TB disease. METHODS AND ANALYSIS: This study uses a mixed-methods approach, with six study components. These are (1) scoping reviews of the literature; (2) qualitative research with patients, carers and healthcare professionals; (3) development of the intervention; (4) a pilot randomised controlled trial of the manualised intervention; (5) a process evaluation to examine clinical utility; and (6) a cost analysis. ETHICS AND DISSEMINATION: This study received ethics approval on 24 December 2018 from Camberwell St. Giles Ethics Committee, UK (REC reference 18/LO/1818). Findings will be published and disseminated through peer-reviewed publications and conference presentations, published in an end of study report to our funder (the National Institute for Health Research, UK) and presented to key stakeholders. TRIAL REGISTRATION NUMBER: ISRCTN95243114 SECONDARY IDENTIFYING NUMBERS: University College London/University College London Hospitals Joint Research Office 17/0726.National Institute for Health Research, UK 16/88/06.

PLoS One ; 14(12): e0226507, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31881023


OBJECTIVE: To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS: Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS: A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION: The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.

Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Criança , Feminino , Humanos , Masculino , Razão de Chances , Medição de Risco , Resultado do Tratamento