Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
Institute of Collective Health (ISC), Federal University of Bahia (UFBA), Salvador, Brazil.
PLoS Negl Trop Dis. 2019 Sep 6;13(9):e0007714. doi: 10.1371/journal.pntd.0007714. eCollection 2019 Sep.
Although leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil.
METHODOLOGY/PRINCIPAL FINDINGS: Using individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25-1.97) and Northeast (OR = 1.44; 95%CI 1.17-1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01-1.69), no income (OR = 1.41; 95%CI 1.07-1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13-1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28-1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10-1.66).
The findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control.
尽管麻风病通过多药疗法基本可以治愈，但治疗不彻底会限制治疗效果，成为疾病控制的重要障碍。为了提高治疗完成率，我们旨在确定与巴西麻风病治疗中断相关的地理和社会经济因素。
方法/主要发现：利用巴西社会项目和法定传染病国家登记处收集的个体参与者数据，并将其作为 1 亿巴西人队列研究的一部分进行链接，我们评估了 2007 年至 2014 年间诊断和随访的 20063 例麻风病例的治疗中断几率。我们使用多变量层次分析调查了地理和社会经济风险因素，并按麻风病亚型和地理区域进行了额外的分层分析。在随访期间，有 1011 例（5.0%）麻风病例被观察到治疗中断。居住在巴西北部（OR=1.57；95%CI 1.25-1.97）和东北部（OR=1.44；95%CI 1.17-1.78）地区的麻风病例治疗中断的几率明显增加。黑种人（OR=1.29；95%CI 1.01-1.69）、无收入（OR=1.41；95%CI 1.07-1.86）、家庭收入≤巴西最低工资的 0.25 倍（OR=1.42；95%CI 1.13-1.77）、家庭非正规照明/无电力供应（OR=1.53；95%CI 1.28-1.82）和人均居住密度>1 人/房间（OR=1.35；95%CI 1.10-1.66）的病例，其违约的可能性也更高。
研究结果表明，巴西麻风病治疗中断的频率在区域上存在差异，并提供了新的证据，表明不利的社会经济条件可能是麻风病治疗完成的重要障碍。这些发现表明，解决社会经济贫困问题的干预措施，以及继续努力改善获得医疗服务的机会，有可能改善麻风病的治疗结果和疾病控制。
