![]() Historically, TB control in the city has been carried out centrally by the local TCP staff in reference centers but, since 2007, all TB control measures have been fully decentralized to the PHC services. São José do Rio Preto (SJRP), a large city in the Northwest of SP, is considered a priority city for TB control, despite its high human and social development index (HDI = 0.834 and Gini index = 0.50). The majority of TB cases are concentrated in the Southeast of Brazil, with São Paulo State (SP) being responsible for 20% of the country’s total burden. ![]() There is scarce data on the effectiveness of such actions focusing on PHC services though. īrazilian guidelines have recommended the expanded investigation of LTBI in contacts of active TB cases and the establishment of LTBI treatment. The Brazilian Ministry of Health (MoH) recommends decentralization of Tuberculosis Control Program (TCP) activities to the Primary Health Care (PHC) services, in an attempt to enhance access to care and provide patient-centered care. īrazil still figures among the 22 countries with the highest burden of TB worldwide. Under field conditions, in most TB programs, it is estimated that over 90% of the potential benefits of LTBI diagnosis and treatment management are lost as a consequence of patient losses and drop-outs, which occur in each step of the therapy (identification, testing, evaluation, prescription, acceptance and completion). ĭespite the evidence in multiple randomized trials that LTBI treatment provides individual benefits, in most settings, this has minimal epidemiologic impact at the population level. For these reasons, the World Health Organization (WHO) considers treatment of LTBI a tool for global TB control, especially in high-risk groups, such as close contacts, individuals infected with the human immunodeficiency virus (HIV), and patients undergoing immunosuppressive therapy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist.ĭiagnosis and treatment of latent tuberculosis infection (LTBI) has the potential to provide both individual benefits (by preventing the morbidity and mortality of active disease) and public health benefits (by preventing further transmission from individuals with reactivated contagious disease). This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: All relevant data are within the paper and its Supporting Information files.įunding: The study was conducted as a part of the TREAT TB program, funded by the US Agency for International Development (USAID), in a virtual approach. Received: JanuAccepted: ApPublished: June 10, 2016Ĭopyright: © 2016 Wysocki et al. Caylà, Public Health Agency of Barcelona, SPAIN ![]() (2016) Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified.Ĭitation: Wysocki AD, Villa TCS, Arakawa T, Brunello MEF, Vendramini SHF, Monroe AA, et al. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Overall, among 267 screened, only 64 (24%) started LTBI treatment. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms.
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