Fatores associados ao abandono do tratamento da tuberculose em um município prioritário do Brasil: um estudo de coorte

Abstract

Objectives: For this work was conducted two studies, aiming: i) to evaluate risk factors for default TB treatment by means of a cohort study (study 1) and ii) to compare the incidence of the outcomes of a subgroup of prevalent and incident cases of TB, followed directly, with another accompanied by indirectly through the records of the department of epidemiology of the municipality (study 2). Methods: Study1: We conducted a cohort study involving tuberculosis patients in referral centers in the city Juiz de Fora (JF), Minas Gerais, in the period 2008-2009, comparing those who were cured (n = 172) with those who have dropout (n = 48). To assess factors associated with dropout, we used multivariate theoretical models for determining three hierarchical levels of explanatory variables (distal, intermediate and proximal). The variables were adjusted for within each level, those with a significance level of p 0.20 were transferred to the upper level. In the final multivariate model, the variables that do not present significant were removed until all variables in the model were significant (p 0.05), reaching a level appropriate to the model setting. Study 2: To compare the effects of closures of TB cases followed directly (n = 287) with indirect (n = 216) form, among the reported (n= 503) of the Notifiable Diseases Information System (SINAN), by JF, 2008-2009, a prospective open cohort study was conducted. Results: Study1: Of the closures directly tracked n= 220, 172 (78.2%) and 48 (21.8%) were cured and abandonment as closures. In the model there is a direct association between the intensity of drug use and the incidence of dropouts, and increasing the risk of abandonment towards ex-users (OR= 4.12, 95% CI 1.11 to 15.20), cocaine users alone or in combination with cannabis (OR= 5.67, 95% CI 1.34 to 24.03) and crack users alone or combined with other drugs (OR= 12.25, 95% CI 3.04 to 49.26). Additionally, individuals who drink heavily have a higher risk of dropping out of treatment that individuals who drank in the last year or drink moderately (OR= 2.94, 95% CI 1.08 to 7.99). Study 2: The number / incidence of dropouts was greater (p<0.05) between the monitored directly (53/18, 5%) compared with the monitored indirectly (6/2, 8%) and even with the total notified to SINAN (14/2, 8%). The relative risk (RR) of noncompliance with direct monitoring group was 6.64 (95% CI 2.91 to 15.18). Anyway, there was a higher incidence of dropouts in the population monitored directly, which mostly remained neglected to SINAN. Conclusion: Evidenced the need for effective measures to improve TB control and data quality SINAN-TB and TB should be seen not only in the physical point of view, but also with the complex relationship with the various social factors outside the health unit, which must be taken into account both the prevention and treatment of disease.