Bartholomay Patricia, Pinheiro Rejane Sobrino, Johansen Fernanda Dockhorn Costa, Oliveira Silvano Barbosa de, Rocha Marli Souza, Pelissari Daniele Maria, Araújo Wildo Navegantes de
Secretaria de Vigilância em Saúde,, Ministério da Saúde, Brasília, Brazil.
Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Cad Saude Publica. 2020;36(5):e00082219. doi: 10.1590/0102-311x00082219. Epub 2020 May 8.
The study aimed to assess the coverage and reliability of drug-resistant tuberculosis (DR-TB) case closure in the Information System on Special Treatments for Tuberculosis (SITE-TB in Portuguese) in Brazil from 2013 to 2016, based on probabilistic linkage with the Information System on Diseases of Notification (SINAN), Laboratory Environment Manager (GAL), and Mortality Information System (SIM). The study population consisted of DR-TB cases that initiated treatment from 2013 to 2016 in Brazil. Linkage with SINAN assessed the coverage and estimated underreporting of DR-TB cases. The capture-recapture method was applied, using the Chapman estimator. Linkage with GAL identified cases diagnosed by the laboratory that had not been reported to SITE-TB. Linkage with SIM assessed the reliability of case closure by death in SITE-TB, using the kappa coefficient. We estimated a population of 2,945 (95%CI: 2,365-3,602) new cases of DR-TB with the Chapman estimator. We located 1,626 individuals in the GAL database that had not been reported to SITE-TB, even with laboratory confirmation of drug resistance. PABAK (prevalance and bias adjusted kappa) of 0.86 (95%CI: 0.85-0.87) was classified as excellent for the agreement in death as the outcome between the SITE-TB and SIM databases. The results pointed to persistent gaps related to diagnosis and treatment of DR-TB in Brazil. Underreporting of DR-TB cases in the SITE-TB database poses a challenge for TB control. Identification of these individuals and early start of treatment should be prioritized in health services.
该研究旨在基于与疾病通报信息系统（SINAN）、实验室环境管理系统（GAL）和死亡信息系统（SIM）的概率关联，评估2013年至2016年巴西结核病特殊治疗信息系统（葡萄牙语为SITE-TB）中耐多药结核病（DR-TB）病例结案的覆盖率和可靠性。研究人群包括2013年至2016年在巴西开始治疗的耐多药结核病病例。与SINAN的关联评估了耐多药结核病病例的覆盖率并估计了漏报情况。采用查普曼估计量应用捕获再捕获方法。与GAL的关联识别出实验室诊断但未报告给SITE-TB的病例。与SIM的关联使用kappa系数评估SITE-TB中因死亡导致的病例结案的可靠性。我们用查普曼估计量估计出2945例（95%置信区间：2365 - 3602）耐多药结核病新病例。我们在GAL数据库中找到了1626名即使有实验室耐药确认但仍未报告给SITE-TB的个体。SITE-TB和SIM数据库之间将死亡作为结局的一致性的PABAK（患病率和偏差调整kappa）为0.86（95%置信区间：0.85 - 0.87），被归类为优秀。结果表明巴西在耐多药结核病的诊断和治疗方面存在持续差距。SITE-TB数据库中耐多药结核病病例的漏报对结核病控制构成挑战。卫生服务中应优先识别这些个体并尽早开始治疗。
