Secretaria Municipal de Saúde, Rio de Janeiro, Brazil.
Centro de Estudos Estratégicos, Fundação Oswaldo Cruz, CEE, Rio de Janeiro, Brazil.
J Public Health (Oxf). 2018 Sep 1;40(3):e359-e366. doi: 10.1093/pubmed/fdx132.
Unsuccessful tuberculosis outcomes are frequent; bold policies are needed to end the tuberculosis (TB) epidemic to attain the third Sustainable Development Goal (SDG) by 2030. We examined the effect of the Family Health Strategy (FHS) and its interactions with the conditional cash transfer programme (CTP) on TB outcomes in Rio de Janeiro, Brazil.
We performed individual-based analyses of a database resulting from deterministic and probabilistic linkages of the TB information system, FHS registries and CTP payrolls. Patients ≥15 years old treated with the standard RHZE regimen were included. The rates of successful outcomes were analysed according to coverage by FHS. Effects from the CTP and its interactions with the FHS were examined among the poorest.
FHS coverage increased the likelihood for successful outcomes by 14% (12-17%) among 13 482 new cases, and by 35% (25-47%) among 1880 retreatment cases. The CTP had an independent effect but no interaction with the FHS among the poorest.
This is the first individual-based study to show a relevant protection of poor urban communities regarding patient-important health outcomes by the Brazilian FHS and CTP. These findings support strategies of universal health coverage, primary care strengthening and social protection to achieve a major SDG.
结核病治疗结果不理想的情况时有发生；为了在 2030 年实现第三个可持续发展目标，需要采取大胆的政策来终结结核病流行。我们研究了家庭健康战略（FHS）及其与有条件现金转移计划（CTP）之间的相互作用对巴西里约热内卢结核病结局的影响。
我们对结核病信息系统、FHS 登记册和 CTP 工资单的确定性和概率链接所产生的数据库进行了基于个体的分析。纳入了接受标准 RHZE 方案治疗的年龄≥15 岁的患者。根据 FHS 的覆盖情况分析了治疗成功的比例。在最贫困人群中，我们考察了 CTP 的作用及其与 FHS 的相互作用。
FHS 的覆盖范围增加了新发病例（13482 例）成功治疗的可能性，增加了 14%（12-17%），也增加了复治病例（1880 例）成功治疗的可能性，增加了 35%（25-47%）。CTP 对最贫困人群有独立影响，但与 FHS 之间没有相互作用。
这是第一项基于个体的研究，表明巴西 FHS 和 CTP 对保护贫困城市社区的患者重要健康结局具有重要意义。这些发现支持全民健康覆盖、加强初级保健和社会保护的战略，以实现一个主要的可持续发展目标。
