Universidade de São Paulo . Faculdade de Saúde Pública . Programa de Pós-Graduação em Saúde Pública . São Paulo , SP , Brasil.
Universidade Nove de Julho . Faculdade de Medicina . Diretoria de Ciências Médicas . São Paulo , SP , Brasil.
Rev Saude Publica. 2020 Nov 2;54:e112. doi: 10.11606/s1518-8787.2020054002108. eCollection 2020.
To describe the spatial and temporal distribution of TB-HIV co-infection, as well as the profile of the characteristics of the co-infected population in the municipality of São Paulo.
This is an ecological and time series study with data from the Tuberculosis Patient Control System (TBWeb), including all new cases of tuberculosis co-infected individuals with HIV living in the municipality from 2007 to 2015. Time trends of the disease were analyzed using Prais-Winsten regression. The cases were geocoded by the address of residence for the elaboration of maps with the incidence rates smoothed by the local empirical Bayesian method. The global and local Moran indexes evaluated spatial autocorrelation. Individuals' profiles were described and the characteristics of the cases with and without fixed residence were compared by Pearson's chi-square or Fisher's exact tests.
We analyzed 6,092 new cases of TB-HIV co-infection (5,609 with fixed residence and 483 without fixed residence). The proportion of TB-HIV co-infection ranged from 10.5% to 13.7%, with a drop of 3.0% per year (95%CI -3.4 - -2.6) and was higher in individuals without fixed residence. Incidence rates decreased by 3.6% per year (95%CI -4.4% - -2.7%), declining from 7.0 to 5.3 per 100,000 inhabitants/year. Co-infection showed positive and significant spatial autocorrelation, with heterogeneous spatial pattern and a high-risk cluster in the central region of the municipality. Cure was achieved in 55.5% of cases with fixed residence and in 32.7% of those without a fixed residence.
The data indicate an important advance in the control of TB-HIV co-infection in the period analyzed. However, we identified areas and populations that were unequally affected by the disease and that should be prioritized in the improvement of actions to prevent and control co-infection.
描述结核病-艾滋病合并感染的时空分布情况，以及圣保罗市合并感染人群的特征概况。
这是一项生态和时间序列研究，数据来自结核病患者控制系统（TBWeb），包括 2007 年至 2015 年期间居住在该市的所有新诊断为结核病合并感染艾滋病毒的个体。采用普赖斯-温斯坦（Prais-Winsten）回归分析疾病的时间趋势。病例按照居住地址进行地理编码，以便利用局部经验贝叶斯方法对发病率进行平滑处理后绘制地图。全局和局部莫兰指数评估空间自相关。描述个体特征，并通过皮尔逊卡方检验或 Fisher 确切概率法比较有固定住所和无固定住所病例的特征。
共分析了 6092 例新诊断的结核病-艾滋病合并感染病例（5609 例有固定住所，483 例无固定住所）。结核病-艾滋病合并感染的比例为 10.5%至 13.7%，每年下降 3.0%（95%可信区间为-3.4%至-2.6%），无固定住所的个体比例较高。发病率每年下降 3.6%（95%可信区间为-4.4%至-2.7%），从 7.0 降至 5.3/100000 居民/年。合并感染存在正显著的空间自相关，空间模式存在异质性，且该市中部地区存在高风险聚集区。有固定住所的病例中，55.5%实现治愈，无固定住所的病例中，32.7%实现治愈。
数据表明，在分析期间，结核病-艾滋病合并感染的控制取得了重要进展。然而，我们发现一些地区和人群受到疾病的影响程度不同，应优先改善预防和控制合并感染的行动。
