Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.
Universidade Federal da Bahia. Instituto de Saúde Coletiva. Departamento de Saúde Coletiva I. Salvador, BA, Brasil.
Rev Saude Publica. 2022 Jun 13;56:53. doi: 10.11606/s1518-8787.2022056004020. eCollection 2022.
To evaluate the performance of tuberculosis control in Brazilian municipalities.
This is an ecological study on Brazilian municipalities that notified at least four new cases of tuberculosis, with a minimum of one new case of pulmonary tuberculosis between 2015 and 2018. The municipalities were stratified according to the population in < 50 thousand, 50-100 thousand, 100-300 thousand, and > 300 thousand inhabitants, and the k-means method was used to group them within each population range according to the performance of six indicators of the disease.
A total of 2,845 Brazilian municipalities were included, comprising 98.5% (208,007/211,174) of new tuberculosis cases in the period. For each population range, three groups (A, B, and C) of municipalities were identified according to the performance of the indicators: A, the most satisfactory; B, the intermediates; and C, the least satisfactory. Municipalities in group A with < 100 thousand inhabitants presented results above the targets for laboratory confirmation (≥ 72%), abandonment (≤ 5%), and cure (≥ 90%), and comprised 2% of new cases of the disease. Conversely, municipalities of groups B and C presented at least five indicators with results below the targets - HIV testing (< 100%), contact investigation (< 90%), directly observed therapy (< 90%), abandonment (> 5%), and cure (< 90%) -, and corresponded to 66.7% of new cases of tuberculosis. In group C of municipalities with > 300 thousand inhabitants, which included 19 of the 27 capitals and 43.1% of new cases of tuberculosis, the lowest percentages of contact investigation (mean = 56.4%) and directly observed therapy (mean = 15.4%) were verified, in addition to high abandonment (mean = 13.9%) and low coverage of primary health care (mean = 66.0%).
Most new cases of tuberculosis occurred in municipalities with unsatisfactory performance for disease control. Expanding the coverage of primary health care in these places can reduce abandonment and increase the contact investigation and directly observed therapy.
评估巴西市级结核病控制的效果。
这是一项针对巴西市级地区的生态学研究，这些地区在 2015 年至 2018 年间至少报告了 4 例新的结核病病例，其中至少有 1 例为肺结核新病例。根据人口数量（<5 万、5 万至 10 万、10 万至 30 万和>30 万）对市级地区进行分层，并在每个人口范围内使用 K-均值方法根据疾病的六个指标的表现对它们进行分组。
共纳入了 2845 个巴西市级地区，占该时期新结核病病例的 98.5%（208007/211174）。根据指标表现，为每个人口范围确定了三组（A、B 和 C）市级地区：A 组为最满意的地区；B 组为中等的地区；C 组为最不满意的地区。人口少于 10 万的 A 组市级地区的实验室确诊（≥72%）、弃治率（≤5%）和治愈率（≥90%）结果均高于目标，占疾病新发病例的 2%。相反，B 组和 C 组的市级地区至少有五个指标的结果低于目标——HIV 检测率（<100%）、接触者调查率（<90%）、直接观察治疗率（<90%）、弃治率（>5%）和治愈率（<90%），占结核病新发病例的 66.7%。在人口超过 300 万的 C 组市级地区中，包括 27 个首府中的 19 个和 43.1%的结核病新发病例，接触者调查率（平均=56.4%）和直接观察治疗率（平均=15.4%）最低，同时弃治率高（平均=13.9%）和初级卫生保健覆盖率低（平均=66.0%）。
大多数结核病新发病例发生在疾病控制效果不理想的市级地区。扩大这些地区的初级卫生保健覆盖范围可以减少弃治率，提高接触者调查率和直接观察治疗率。
