Retreatment and Anti-tuberculosis Therapy Outcomes in Brazil Between 2015 and 2022: A Nationwide Study

被引：0

作者：

Barreto-Duarte, Beatriz ^{[1
,2
,3
,4
,5
]}

Villalva-Serra, Klauss ^{[1
,3
]}

Miguez-Pinto, Joao P. ^{[1
,3
]}

Araujo-Pereira, Mariana ^{[3
,4
,5
]}

Campos, Vanessa M. S. ^{[1
,3
]}

Rosier, Gabriela ^{[3
,4
,6
]}

Nogueira, Betania M. F. ^{[3
,4
,7
]}

Queiroz, Artur T. L. ^{[3
,8
]}

Rolla, Valeria C. ^{[9
]}

Cordeiro-Santos, Marcelo ^{[10
,11
,12
]}

Kritski, Afranio L. ^{[2
,13
]}

Martinez, Leonardo ^{[14
]}

Rebeiro, Peter F. ^{[5
,15
]}

Sterling, Timothy R. ^{[5
,15
]}

Rodrigues, Moreno M. ^{[3
,16
]}

Andrade, Bruno B. ^{[1
,2
,3
,4
,5
,6
,7
,15
]}

机构：

[1] Univ Salvador, Curso Med, Salvador, Brazil

[2] Univ Fed Rio de Janeiro, Fac Med, Programa Posgrad Clin Med, Rio de Janeiro, Brazil

[3] Multinatl Org Network Sponsoring Translat & Epidem, Inst Res Prior Populat, Salvador, Brazil

[4] Clariens Educ, Fac Zarns, Inst Pesquisa Clin & Translac, BR-41741590 Salvador, BA, Brazil

[5] Fundacao Oswaldo Cruz, Lab Pesquisa Clin & Translac, Inst Goncalo Moniz, Rua Waldemar Falcao,121, BR-40296710 Salvador, BA, Brazil

[6] Escola Bahiana Med & Saude Publ, Programa Posgrad Med & Saude Humana, Salvador, Brazil

[7] Univ Fed Bahia, Programa Posgrad Ciencias Saude, Salvador, Brazil

[8] Fundacao Oswaldo Cruz, Ctr Data & Knowledge Integrat Hlth, Inst Goncalo Moniz, Salvador, Brazil

[9] Fundacao Oswaldo Cruz, Inst Nacl Infectol Evandro Chagas, Rio de Janeiro, Brazil

[10] Fdn Med Trop Doutor Heitor Vieira Dourado, Dept TB, Manaus, Brazil

[11] Univ Estado Amazonas, Programa Posgrad Med Trop, Manaus, Brazil

[12] Univ Nilton Lins, Fac Med, Manaus, Brazil

[13] Univ Fed Rio de Janeiro, Programa Acad TB, Fac Med, Rio de Janeiro, Brazil

[14] Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA

[15] Vanderbilt Univ, Sch Med, Dept Med, Div Infect Dis, Nashville, TN USA

[16] Fundacao Oswaldo Cruz, Lab Analise & Visualizacao Dados, Porto Velho, Brazil

来源：

OPEN FORUM INFECTIOUS DISEASES | 2024年 / 11卷 / 08期

关键词：

epidemiology; loss to follow-up; retreatment; treatment outcome; tuberculosis; TUBERCULOSIS; PREDICTORS;

D O I：

10.1093/ofid/ofae416

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background 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.Methods 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.Results 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.Conclusions 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. This study represents a nationwide analysis of tuberculosis cases in Brazil, emphasizing the impact of prior treatment on patient outcomes. Furthermore, it investigates retreatment within the Brazilian healthcare system, providing insights for targeted tuberculosis control measures.

引用

页数：9

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