Banca de DEFESA: NINFA MARLEN CHAVES TORRES
Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.DISCENTE : NINFA MARLEN CHAVES TORRES
DATA : 07/07/2020
HORA: 09:00
LOCAL: De forma remota (online)
TÍTULO:
DETERMINANTS OF HEALING AND DEATH IN PATIENTS WITH TUBERCULOSIS: A CASE STUDY IN BRAZIL AND COLOMBIA
PALAVRAS-CHAVES:
Tuberculosis; MDR; Risk factors; Health institutions; Treatment results; Cure, death
PÁGINAS: 155
GRANDE ÁREA: Ciências da Saúde
ÁREA: Medicina
RESUMO:
Tuberculosis (TB) remains the most important cause of death from a single infectious microorganism in the world, it is estimated that 10 million people developed the disease in 2018 worldwide, but it may still be neglected in many countries. This situation may be related to a limited evaluation of treatment results in countries with limited resources, as well as the presence of factors that affect the outcome of TB treatment. Objective: To identify determinants of cure and death in patients with tuberculosis. To determine the association between the volume of tuberculosis patients treated in the Health Service per year and the successful treatment of tuberculosis patients in Brazil. Determine the risk factors for death in patients with tuberculosis in Brazil. Determine risk factors for therapeutic failure among patients with resistance to rifampicin in Colombia. Methodology: An exhaustive literature review was carried out on the results of tuberculosis treatment and the health facilities that care for / assist patients with tuberculosis. A retrospective cohort study was conducted based on secondary data from cases diagnosed and reported as TB, who started treatment between January 2013 and December 2015 in Brazil and the cases of TB resistant to rifampicin in Colombia. The national TB control programs in Brazil and Colombia provided the data. The databases were cleaned and anonymized to be imported into the SPSS version 18. Statistical, descriptive and analytical analyzes were performed. Results: 144 studies were included in the review "Predictive factors for successful treatment of tuberculosis: a systematic review with meta-analysis". The success rate for the treatment of drug-sensitive TB in adults was 80.4% (95% CI: 78.6-82.1). 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 83.4% (95% CI: 71.0-92.9); in patients coinfected with HIV, it was 70.5% (95% CI: 62.8-77.6), and in patients with multidrugresistant tuberculosis (MDR-TB), it was 58.4% (95% CI: 51.4-64.6). 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 2.1; 1.8 - 2.5), 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. 22 articles met the inclusion criteria in the review "Performance of health facilities in the care of tuberculosis patients in Brazil: a literature review”. It was identified that in Brazil, the health services that act as a gateway for tuberculosis patients are emergency care and primary care, both of which have weaknesses to identify the cases, in addition, primary care has difficulty in retaining patients and hospitals have high rates of transfer and death. In the case of Brazil, 259 325 TB cases were registered at SINAN between 2013 and 2015, 13 339 were eliminated due to duplicates or lack of data, 245 986 eligible patients remained, of whom only 71 249 new confirmed TB cases were selected; 6 736 (65.6%) were seen in basic health units (UBS), 13 591 (19.1%) in TB reference clinics or centers, 8 631 (12.1%) in hospitals and 2 291 (3.2%) in other types of establishments such as emergency rooms and surveillance and management units. The median age was 37.5 years (IQ 27-51.6), the majority were men 49 477 (69.4), education was ≤8 years in 32 044 (45.0%) of the patients, the race / skin color 32 187 (45.2%) called themselves brown / mulatto, 5 644 (7.9%) were HIV positive and 5 415 (7.6%) had diabetes. In this cohort in general 55 195 (77.5%) of the patients were cured, 8 163 (11.5) abandoned the treatment, 3 853 (5.4) died, 2 959 (4.2) transfers, 197 (0.3%) bankruptcy and 882 (1.2) turned to MDR TB. The basic health units had the highest percentage of cure with 82.6%, with the lowest percentage of abandonment 10.9% and death 2.8%, however the hospitals had the lowest percentage of cure 47.9% with the highest percentage of abandonment 13% and death 21.5%. In the UBS: the female gender and the DOTs strategy in the UBS that provided the treatment were associated with the treatment's success; however, HIV positive and alcohol consumption were associated with death. In clinics: only the DOTs strategy in the clinic that provided the treatment was associated with successful treatment and HIV positive was associated with. In hospitals: HIV, alcohol consumption was associated with death. In other establishments: age between 15 and 65 years and the DOTs strategy in the establishment was associated with successful treatment. Conclusion: The UBS that treated less than 20 patients, the clinics that treated between three and nine patients, and the hospitals that treated less than 10 patients in the 3 years were more likely to successfully treat TB. In general, treating less than 50 patients over a 3-year period has been successfully associated with TB treatment in Brazil. In general, DOTS has been successfully associated with the treatment of TB in UBS and Clinics and HIV positive has been associated with death. In Colombia, 50.1% of patients with RR-TB who started treatment between January 2013 and December 2015 had unfavorable treatment results and 19.7% died during treatment. This high rate of unfavorable treatment outcomes was associated with affiliation with the subsidized health regime and age ≥ 60 years.
MEMBROS DA BANCA:
Interno - 287953 - CARLOS ROBERTO BRITES ALVES
Externo à Instituição - CHARLESTON RIBEIRO PINTO
Externo à Instituição - CÉLIA REGINA MAYORAL PEDROSO JORGE - UFBA
Interno - 2292247 - LILIANE ELZE FALCAO LINS KUSTERER
Externo à Instituição - NORMAN GIOVANNI APRÁEZ IPPOLITO - UNC