Cordeiro Dinah Carvalho, Kuabara Pedro, Amaral Bruna Chiarini, Portugal Lucas Maia, Sacramento Daniel Souza, Rodrigues de Oliveira Larissa, Faria Jorgiane da Costa Ferreira, Paolino Priscilla Wolter, Vilanova Vanessa Cordeiro, de Melo Mayara de Sá Cavalcanti, Waechter Cristina Bettin, Trajman Anete
Programa de Pós-graduação em Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Secretaria Municipal de Saúde de Manaus, Manaus, Amazonas, Brazil.
PLoS One. 2025 Jun 27;20(6):e0326428. doi: 10.1371/journal.pone.0326428. eCollection 2025.
This study aims to conduct a needs and preparedness assessment of public primary care units to scale up tuberculosis infection diagnosis and tuberculosis preventive treatment in 5 Brazilian capitals. This observational operational study was carried out across five Brazilian high tuberculosis-burden cities. Clinics with at least one monthly new tuberculosis case were included. Data on Purified Protein Derivative (PPD) storage, tuberculin skin testing (TST) and interferon-gamma release assay (IGRA) availability, personnel qualified for performing TST, radiological facilities and tuberculosis preventive treatment drug availability, were gathered between August 2023 and January 2024. Out of 285 clinics included, 78% (CI95%: 73%-82%) did not offer TST on-site, with only 28% (CI95%: 22%3%) having staff qualified to perform TST, and 35% (CI95%: 29%-40%) lacking dedicated refrigerators for PPD storage. Most (97%, CI95%: 94%-99%) clinics did not collect IGRA testing, with an average distance of 6.7 km (CI95%: 5%-7%) to IGRA labs and a turnaround time of 11.7 days (CI95%: 9%13%) for results. Most (87%, CI95%: 83%-91%) do not offer on-site radiological testing. The primary care network was unprepared to scaling up tuberculosis infection testing. Key issues include unavailability of TST mainly because of insufficient qualified personnel. Without accelerated qualification of staff for TST, scaling up tuberculosis preventive treatment will be impossible.
本研究旨在对巴西5个首府城市的公立基层医疗单位进行需求和准备情况评估，以扩大结核病感染诊断和结核病预防性治疗的规模。这项观察性操作研究在巴西5个结核病负担较重的城市开展。纳入了每月至少有1例新结核病病例的诊所。在2023年8月至2024年1月期间收集了关于纯蛋白衍生物（PPD）储存、结核菌素皮肤试验（TST）和干扰素-γ释放试验（IGRA）可用性、具备进行TST资格的人员、放射设施以及结核病预防性治疗药物可用性的数据。在所纳入的285家诊所中，78%（95%置信区间：73%-82%）未提供现场TST，只有28%（95%置信区间：22%-33%）有具备进行TST资格的工作人员，35%（95%置信区间：29%-40%）缺乏用于PPD储存的专用冰箱。大多数诊所（97%，95%置信区间：94%-99%）未开展IGRA检测，到IGRA实验室的平均距离为6.7公里（95%置信区间：5%-7%），结果周转时间为11.7天（95%置信区间：9%-13%）。大多数诊所（87%，95%置信区间：83%-91%）不提供现场放射学检测。基层医疗网络没有做好扩大结核病感染检测的准备。关键问题包括主要由于合格人员不足而无法进行TST。如果不加快工作人员进行TST的资格认证，扩大结核病预防性治疗将无法实现。
