Barreto-Duarte Beatriz, Villalva-Serra Klauss, Miguez-Pinto João P, Araújo-Pereira Mariana, Campos Vanessa M S, Rosier Gabriela, Nogueira Betânia M F, Queiroz Artur T L, Rolla Valeria C, Cordeiro-Santos Marcelo, Kritski Afrânio L, Martinez Leonardo, Rebeiro Peter F, Sterling Timothy R, Rodrigues Moreno M, Andrade Bruno B
Curso de Medicina, Universidade Salvador, Salvador, Brazil.
Programa Pós-graduação de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Open Forum Infect Dis. 2024 Jul 18;11(8):ofae416. doi: 10.1093/ofid/ofae416. eCollection 2024 Aug.
Adherence to anti-tuberculosis treatment (ATT) in Brazil remains a challenge in achieving the goals set by the World Health Organization (WHO). Patients who are lost to follow-up during treatment pose a significant public health problem. This study aimed to investigate the factors associated with unfavorable ATT outcomes among those undergoing retreatment in Brazil.
We conducted an observational study of patients aged ≥18 years with tuberculosis (TB) reported to the Brazilian National Notifiable Disease Information System between 2015 and 2022. Clinical and epidemiologic variables were compared between the study groups (new cases and retreatment). Regression models identified variables associated with unfavorable outcomes.
Among 743 823 reported TB cases in the study period, 555 632 cases were eligible, consisting of 462 061 new cases and 93 571 undergoing retreatments (44 642 recurrent and 48 929 retreatments after loss to follow-up [RLTFU]). RLTFU (odds ratio [OR], 3.96 [95% confidence interval {CI}, 3.83-4.1]) was a significant risk factor for any type of unfavorable ATT. Furthermore, RLTFU (OR, 4.93 [95% CI, 4.76-5.11]) was the main risk factor for subsequent LTFU. For death, aside from advanced age, living with HIV (OR, 6.28 [95% CI, 6.03-6.54]) was the top risk factor.
Retreatment is a substantial risk factor for unfavorable ATT outcomes, especially after LTFU. The rates of treatment success in RLTFU are distant from the WHO End TB Strategy targets throughout Brazil. These findings underscore the need for targeted interventions to improve treatment adherence and outcomes in persons who experience RLTFU.
在巴西，坚持抗结核治疗（ATT）仍是实现世界卫生组织（WHO）设定目标的一项挑战。治疗期间失访的患者构成了重大的公共卫生问题。本研究旨在调查巴西接受再治疗的患者中与不良ATT结果相关的因素。
我们对2015年至2022年期间向巴西国家法定传染病信息系统报告的年龄≥18岁的结核病（TB）患者进行了一项观察性研究。比较了研究组（新发病例和再治疗病例）之间的临床和流行病学变量。回归模型确定了与不良结果相关的变量。
在研究期间报告的743823例TB病例中，555632例符合条件，包括462061例新发病例和93571例接受再治疗的病例（44642例复发病例和48929例失访后再治疗病例[RLTFU]）。RLTFU（比值比[OR]，3.96[95%置信区间{CI}，3.83 - 4.1]）是任何类型不良ATT的重要危险因素。此外，RLTFU（OR，4.93[95%CI，4.76 - 5.11]）是随后失访的主要危险因素。对于死亡，除了高龄外，感染艾滋病毒（OR，6.28[95%CI，6.03 - 6.54]）是首要危险因素。
再治疗是不良ATT结果的重要危险因素，尤其是在失访后。巴西各地RLTFU患者的治疗成功率远未达到WHO终止结核病战略目标。这些发现强调了需要采取有针对性的干预措施，以提高经历RLTFU患者的治疗依从性和治疗效果。
