Laylla Ribeiro Macedo

Directly observed therapy of tuberculosis in Brazil: associated determinants and impact on treatment outcome.

SETTING All Brazilian states. OBJECTIVES To assess the determinants of tuberculosis (TB) in patients undergoing directly observed therapy (DOT) and the impact of DOT on treatment outcomes. DESIGN This is a cross-sectional study among TB patients aged ⩾18 years conducted in 2011. The primary outcome was the status of DOT received, while the secondary was the outcome of anti-tuberculosis treatment. RESULTS In 2011, 35 775 (38.3%) subjects received DOT. The odds of receiving DOT were higher in patients with the following characteristics: brown/mestizo patients (OR 1.18, 95%CI 1.14-1.22) and those of other ethnic groups (OR 2.01, 95%CI 1.79-2.27) compared to Whites, alcohol users (OR 1.37, 95%CI 1.28-1.47) and those with mental disorders (OR 1.88, 95%CI 1.54-2.29). The odds of receiving DOT were lower in human immunodeficiency virus positive patients (OR 0.64, 95%CI 0.60-0.68). Patients who did not receive DOT were more likely to default from anti-tuberculosis treatment (OR 0.62, 95%CI 0.57-0.66), die due to TB (OR 0.68, 95%CI 0.61-0.77) and to have unknown treatment outcomes (OR 0.71, 95%CI 0.66-0.76). The adjusted preventable fraction of DOT in the reduction of unfavorable outcomes was 25%. CONCLUSION Sociodemographic and clinical characteristics are determinants of anti-tuberculosis treatment outcomes in patients undergoing DOT; DOT use led to a 25% reduction in unfavorable outcomes.

Vigilância epidemiológica da tuberculose em presídios do Espírito Santo

Objective: To identify the epidemiological profile of tuberculosis cases diagnosed during the period from July 2009 to July 2010 in the inmate population of prison facilities situated in the state of Espirito Santo (ES). Methods: Epidemiologic, descriptive and retrospective survey comprising the diagnosed tuberculosis cases in the 27 prison units in ES administered by the State Secretariat of Justice (Secretaria de Estado da Justica - SEJUS) during the studied period. The data was collected from the review of the standard tuberculosis monitoring records, when the population was characterized by the variables: gender, age range, form of tuberculosis, outcome of the case and location. Descriptive statistics was used by means of tables and graphics. Results: 167 tuberculosis cases were observed (incidence rate of 1,962.6 per 100 thousand prisoners). Male gender had higher number of patients, as well as the 25 to 36 age group and the pulmonary clinical form. On the cases outcome, it is highlighted that 167 (65.3) patients were discharged after being cured and two patients died during the period, the rate of tuberculosis mortality being 11.7 per 100,000 prisoners. The highest tuberculosis incidence was found in patients in prison units of the metropolitan region and a small number of cases occurred in other locations outside the prisons facilities. Conclusion: Cases were mainly male, aged 26 to 35, carriers of the pulmonary form of tuberculosis, coming from the metropolitan region of the state and having discharge/healing as the outcome. doi:10.5020/18061230.2013.p216