Evolução temporal e os fatores associados ao insucesso do tratamento da tuberculose no período de 2011 a 2021, Manaus, Amazonas

Abstract

Introduction: Brazil is one of the relevant countries for tuberculosis worldwide. In the country, Amazonas and its capital, Manaus, are the highlights of incidence, mortality and treatment abandonment. To effectively cope with the disease, it is necessary to evaluate the influence of factors associated with the individual, health programs and social aspects that influence treatment unsuccessful outcomes. Objective: to identify the temporal evolution and factors associated with tuberculosis treatment unsuccessful outcomes from 2011 to 2021, in the city of Manaus, Amazonas. Methods: Epidemiological, ecological study with a quantitative approach on the temporal distribution of tuberculosis incidence and disease treatment outcomes in Manaus, as well as factors associated with treatment outcomes, from 2011 to 2021. Secondary data from the Notifiable Diseases Information System and the Brazilian Institute of Geography and Statistics. The variables refer to te incidence rate, the treatment outcomes of tuberculosis cases and associated factors grouped as patient vulnerability, according to the theoretical model: individual, programmatic and social. The analyzes followed the logic: temporal distribution analysis, using the Shapiro-Wilk test, to test data normality, and linear regression, to analyze trends in the incidence rate and propotion of treatment outcomes of tuberculosis cases according to years of age study; and, analisys of associated factors using the chi-squared test, with a significance of 5%. Odds ratio estimates with confidence intervals were obtained using multivariate logistic regression, considering a hierarchical model. Results: The incidence rate increased. The cure rate decreased and the rate of treatment abandonment and other outcomes increased. Cases of treatement unsuccessful have increased, according to years of study. The following factors present a greater chance of unsuccessful in Tuberculosis treatment: individual vulnerability (age range between 20 and 29 years and over 60 years, indigenous race, HIV+, drug use); programmatic vulnerability (not taking na HIV test), social vulnerability (special population: homeless population, people deprived of liberty, health professionals, immigrants, residentes of collective institutions). Conclusion: the trend towards a reduction in cure and na increase in unsuccessful needs to be observed by the municipal program, considering the influence of vulnerabilities, in particular, individual vulnerability, which showed the strongest association with unsuccessful.