Laboratory of Epidemiology, Federal University of Espirito Santo, Vitoria, Brazil.
Department of Public Health, University of Brasilia, Brasilia, Brazil.
Lancet Glob Health. 2019 Feb;7(2):e219-e226. doi: 10.1016/S2214-109X(18)30478-9. Epub 2018 Dec 21.
Social protection interventions might improve tuberculosis outcomes and could help to control the epidemic in Brazil. The aim of this study was to evaluate the independent effect of the Bolsa Familia Programme (BFP) on tuberculosis treatment outcomes in Brazil.
We prospectively recruited and followed up individuals (aged ≥18 years) who initiated tuberculosis treatment at 42 health-care centres across seven cities in Brazil, between March 1, 2014, and April 30, 2017. Patients were interviewed at health-care centres and information about individual characteristics, socioeconomic status, living conditions, lifestyle, and comorbidities was recorded. Patients were separated into two groups according to BFP beneficiary status: BFP (exposed) or non-BFP (not exposed). Treatment outcome (cure, dropout, death, or development of drug-resistant tuberculosis or treatment failure) was recorded after 6 months of therapy. Pearson's χ test and ANOVA were used to compare tuberculosis treatment outcomes between the two groups, and we estimated the propensity score of being a beneficiary of the BFP using a logit model. We used multinomial regression models to evaluate the effect of the BFP on tuberculosis treatment outcomes.
1239 individuals were included in the study, of whom 196 (16%) were beneficiaries of the BFP and 1043 (84%) were not. After 6 months of treatment, 912 (87%) of 1043 patients in the non-BFP group and 173 (88%) of 196 patients in the BFP group were cured of tuberculosis, 103 (10%) patients in the non-BFP group and 17 (9%) patients in the BFP group had dropped out, and 25 (3%) patients in the non-BFP group and six (3%) patients in the BFP group had died. Three (<1%) of 1043 patients in the non-BFP group developed drug-resistant tuberculosis. Being a BFP beneficiary had a positive effect for cure (average effect 0·076 [95% CI 0·037 to 0·11]) and a negative effect for dropout (-0·070 [-0·105 to 0·036]) and death (-0·002 [-0·021 to 0·017]).
BFP alone had a direct effect on tuberculosis treatment outcome and could greatly contribute to the goals of the WHO End TB Strategy.
Brazilian National Council for Scientific and Technological Development (CNPq) and Brazilian Ministry of Health Department of Science and Technology (DECIT).
社会保护干预措施可能改善结核病结局，并有助于控制巴西的疫情。本研究旨在评估“家庭补助金计划”（Bolsa Familia Programme，BFP）对巴西结核病治疗结局的独立影响。
我们前瞻性招募并随访了 2014 年 3 月 1 日至 2017 年 4 月 30 日期间在巴西 7 个城市的 42 个医疗中心开始结核病治疗的年龄≥18 岁的个体。在医疗中心对患者进行访谈，并记录个体特征、社会经济地位、生活条件、生活方式和合并症的信息。根据 BFP 受益情况将患者分为两组：BFP（暴露）或非 BFP（未暴露）。在治疗 6 个月后记录治疗结局（治愈、脱落、死亡、耐多药结核病或治疗失败）。使用 Pearson χ检验和 ANOVA 比较两组的结核病治疗结局，并用 logit 模型估计成为 BFP 受益人的倾向评分。使用多项回归模型评估 BFP 对结核病治疗结局的影响。
本研究共纳入 1239 名患者，其中 196 名（16%）为 BFP 受益人，1043 名（84%）为非 BFP 受益人。治疗 6 个月后，非 BFP 组 1043 名患者中有 912 名（87%）治愈，BFP 组 196 名患者中有 173 名（88%）治愈；非 BFP 组 103 名（10%）患者脱落，BFP 组 17 名（9%）患者脱落；非 BFP 组 25 名（3%）患者死亡，BFP 组 6 名（3%）患者死亡。非 BFP 组中有 3 名（<1%）患者发生耐多药结核病。成为 BFP 受益人对治愈有积极影响（平均效应 0.076[95%CI 0.037 至 0.11]），对脱落有消极影响（-0.070[-0.105 至 0.036]），对死亡有消极影响（-0.002[-0.021 至 0.017]）。
BFP 单独对结核病治疗结局有直接影响，可极大地促进世界卫生组织终止结核病战略的目标。
巴西国家科学技术发展理事会（CNPq）和巴西卫生部科学技术司（DECIT）。
