Fatores epidemiológicos associados ao insucesso no tratamento da tuberculose em cenário de elevada incidência, Brasil, 2007-2009

Abstract

Prevalence rates and incidence of tuberculosis (TB) have presented significant reduction worldwide. Still, the disease remains a public health problem, with quite heterogeneous magnitude and distribution in the world, as well in Brazilian regions, states and municipalities. Among the factors contributing to the persistence of TB, we highlight socioeconomic issues, health service-related and unsuccessful treatment, especially treatment default. In order to identify factors associated with unsuccessful treatment by abandonment and death during TB treatment in a scenario of high incidence in Brazil and the profile of cases of TB unsuccessful treatment failure, we conducted a retrospective epidemiological study with data from the Information System for Notifiable Diseases of TB from 2007 to 2009. The profile of cases with unsuccessful treatment and their frequencies and proportions, with a confidence interval of 95%, were detected. To identify associated factors, analysis was performed using crude logistic regression and adjusted modeling in automated stepwise backward at the 20% level for inclusion of variables, keeping in the final model those with a 5% significance. The adequacy of the model was assessed by deviance analysis and the Hosmer and Lemeshow test. Odds ratio was the measure of association used. Treatment default remained as the main category of unsuccessful treatment outcome, but the outcomes for death and transfer also contribute heavily to not achieve the goal of curing cases. The strongest associations for abandonment were: Reentrance post-abandonment (aOR = 4.95), age group 0-24 years and 25-44 years, both with aOR = 2.48, Serology for HIV not done (aOR = 1, 80); and unsuccessful for death were: state of Mato Grosso do Sul (aOR = 1.99), age 65 years or older (aOR = 10.32), mixed clinical form (aOR = 1.80), Sputum baciloscopy not performed (aOR = 2.04), and Serology for HIV + (aOR = 3.89). Despite the influence of individual factors in the TB unsuccessful treatment outcome, we observed strong contribution of factors related to health services that, when considering the profile of cases can implement measures aimed successful treatment outcome