Desfechos clínicos da tuberculose utilizando o esquema com dose fixa combinada em Contagem, Minas Gerais

Abstract

Tuberculosis demand strategies to deal their control. In 2009, the National Program for Tuberculosis Control recommended tablets in Combined Fixed Dose. There are few studies following the introduction of the new scheme Fixed Dose Combined, so it is important to know what factors can influence for the outcome in the treatment of tuberculosis. The aim of the study was to evaluate the clinical outcomes of tuberculosis treatment after the introduction of the scheme Fixed-Dose Combination in Contagem, Minas Gerais. The study was a prospective cohort consisting of all patients diagnosed with tuberculosis (new cases) treated at Basic Units in Contagem, Minas Gerais, (n = 83), 18 years old, and excluded cases of retreatment, treated outside the unit Basic or in another municipality and patients who have not completed the process before the end of the study. Data were collected through three interviews that took place at the end of the first month, end of the second month and the end of the sixth month, to assess sociodemographic characteristics (sex, age, education) and economic (income), behavioral (illicit drugs and smoking) and clinical characteristics (comorbidities), directly observed treatment and alcoholism. In addition to the features related to drug treatment (adhesion, understanding, directly observed treatment and pharmacotherapeutic profile).The magnitude of the association was estimated through oddsratio.For all analyzes the level of significance was set at p 0.05 and CI 95%. The variables for logistic regression model univariate controlled the time of abandonment between the first and second interview were adjusted. Variables with p values equal to or less than 0.20 in the Wald test in the univariate analysis were selected manually to start the model of multivariate analysis with step-by-step procedure to check back. Multivariate analysis was used to evaluate the association between the explanatory variables and the outcome variable response: healing and abandonment. Fit test was carried out of the Hosmer & Lemeshow model. In this case, to demonstrate that the model was accepted, the null hypothesis should be accepted, that is, the value of p> 0.05. The cure rate was 77.1% (64/83), the abandonment of 20.5% (17/83) and there were no cases of bankruptcy or death. The frequency of adherence to treatment was high (71.1%). The level of understanding of the treatment was inadequate for most patients 60/83 (72.3%). The higher the number of medications in use exponentially increases the chance of quitting (OR 1.72). Patients of the brown race, alcoholics and living with the Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome were significantly associated with abandonment (p = 0.039, p = 0.002 and p = 0.001, respectively). Understanding also significantly associated with abandonment (p = 0.01 and OR 5,76e CI 1.49 to 22.29). The likelihood of dropping out in the first months was higher than in subsequent months. This study demonstrates that patients with tuberculosis have understood the treatment, the results could be more favorable for curing.