College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
Federal University of São Carlos, São Carlos, São Paulo, Brazil.
J Infect Dev Ctries. 2021 Nov 30;15(11):1661-1669. doi: 10.3855/jidc.14843.
Prisons are high-risk settings for drug-resistant tuberculosis because the prevalence of the tuberculosis (TB) is much higher than in the general population. This study to investigated the factors associated with drug-resistant tuberculosis in prisons in the state of São Paulo, Brazil.
Retrospective cohort of drug-resistant TB cases for incarcerated people in São Paulo state, reported in the Tuberculosis Patient Control System between 2006 and 2016. To analyze the factors associated with drug-resistant TB, the backward method (likelihood ratio) was used, determining the adjusted odds ratio and respective 95%CI coefficients. Multiple models were proposed to adjust for potential confusion and interaction. The best fit model was selected based on the lowest Akaike information criterion coefficient.
In total, 473 drug-resistant tuberculosis cases were reported in the prison population of Sāo Paulo state, the majority were male. The cases that presented negative results for sputum smear and sputum culture had, respectively, an aOR=0.6 and aOR=0.16 for drug-resistant tuberculosis in relation to the cases with positive results. The cases where the patient had AIDS and reported alcoholism, respectively, an aOR=1.47 and aOR=1.60 for drug-resistant TB. Individuals with a background treatment history for TB presented a stronger association with drug-resistant tuberculosis, aOR=35.08.
Sputum spear, sputum culture, chest X-ray, AIDS, alcoholism and background treatment history for TB were factors associated with resistance to antituberculosis drugs among prisoners. This is useful for the implementation of disease control measures related to the detection and monitoring of cases in the prison system.
监狱是耐多药结核病的高风险环境，因为结核病（TB）的患病率远高于普通人群。本研究旨在调查巴西圣保罗州监狱中与耐多药结核病相关的因素。
回顾性队列研究纳入了 2006 年至 2016 年期间在结核病患者控制系统中报告的圣保罗州被监禁者中的耐多药结核病病例。为了分析与耐多药结核病相关的因素，采用向后法（似然比），确定调整后的优势比和相应的 95%置信区间系数。提出了多个模型来调整潜在的混淆和相互作用。根据最低的 Akaike 信息准则系数选择最佳拟合模型。
共报告了圣保罗州监狱人口中的 473 例耐多药结核病病例，大多数为男性。痰涂片和痰培养结果为阴性的病例，与阳性结果的病例相比，耐多药结核病的 aOR 分别为 0.6 和 0.16。患有艾滋病和报告酗酒的病例，耐多药结核病的 aOR 分别为 1.47 和 1.60。有结核病背景治疗史的个体与耐多药结核病的相关性更强，aOR 为 35.08。
痰涂片、痰培养、胸部 X 光、艾滋病、酗酒和结核病背景治疗史是与囚犯中抗结核药物耐药相关的因素。这有助于实施与监狱系统中病例检测和监测相关的疾病控制措施。
