Effect of social, economic and health system aspects on the diagnostic and therapeutic cascade of multidrug-resistant tuberculosis in patients treated in Lisbon and Rio de Janeiro

• Autor(a) principal: Bhering, Marcela
• Data de Publicação: 2024
• Outros Autores: Kritski, Afranio
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://doi.org/10.25761/anaisihmt.459

Introduction: State of Rio de Janeiro (ERJ) and District of Lisbon (DL) have a high concentration of cases of drug-resistant tuberculosis (DR-TB). Objectives: To compare the Epidemiological Surveillance of multidrug-resistant (MDR) TB in ERJ and DL, in order to understand the differences and similarities. Methods: Retrospective study with a quantitative and qualitative approach. MDR-TB data were extracted from SITE-TB, from 2000 to 2016, and from SVIG-TB, from 2000 to 2014, in ERJ and DL, respectively. Multivariate regressions were performed to estimate factors associated with treatment outcomes. For ERJ, the trend of primary MDR-TB, the proportion and factors associated with underreporting were estimated. At ERJ and DL, in qualitative research, semi-structured interviews were carried out with patients and health professionals, and thematic content analysis was used. Results: Treatment failure was 30.5% in DL and 44.3% in ERJ. In DL, foreign patients were 4.5 times more likely to be lost to follow-up. In ERJ, XDR-TB cases were 4.7 times more likely to fail. In ERJ, there was an increase in cases of primary MDR-TB between 2000-2019 and an underreporting of 25.4% of the cases analyzed. In the qualitative study, problems of social inequality associated with the ethnic origin of populations were observed. In DL, there was a more agile diagnosis of resistance, greater social support for risk groups and more modern medicines, while in ERJ there was better biosafety and more human resources. Conclusion: in DL there is a more patient-centered treatment, while in ERJ there is a low performance of the flow between sample collection and diagnosis and treatment of resistance and the absence of public policies that support patients with DR-TB, compromising effectiveness of the treatment. It is suggested that new strategies be developed in the DL to improve the adherence of foreign patients through actions that involve these communities. In ERJ, with the low performance of the diagnostic and therapeutic cascade, with the increase in transmission of primary MDR-TB, it is urgent to optimize the use of molecular tests that detect DR as the first approach, speed up the early diagnosis of drug resistance and improve evaluation of contacts.