Efetividade da Rede de Atenção à Saúde para Hanseníase em Minas Gerais

Abstract

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, with the potential to cause progressive physical disabilities if not diagnosed and treated early. Unequal access to health services, the endemicity rate and sociodemographic factors have an impact on clinical outcomes in the Health Care Network (RAS/MG). Objective: To analyze the effectiveness of early diagnosis, immediate treatment and control of leprosy physical disabilities in the RAS/MG. Methodology: This is an analytical ecological time series study using data on new leprosy cases notified on Sinan (2014-2023). Demographic information was obtained from DATASUS and IBGE, and the notifying units from CNES. The analysis was carried out using Microsoft Excel and Stata/IC 16.0, with multivariate logistic regression and Prais-Winsten models to assess temporal trends (significance level: 5%). The study was approved by the UFMG Research Ethics Committee. Results: In the period analyzed, 10,402 new cases were diagnosed. Early diagnosis remained stationary, with a predominance of treatment initiation <2 days (stationary) and >2 days (decreasing). Disability control showed a downward trend. Men had a higher risk of late diagnosis, while women had a higher probability of early diagnosis and immediate treatment initiation. However, men had better results in disability recovery. Self-declared black and brown individuals had less access to early diagnosis, but a greater chance of worsening the degree of physical disability (GIF). Whites, on the other hand, had a greater chance of early diagnosis and immediate treatment, but less chance of recovery. Patients with incomplete higher education had a higher chance of immediate treatment and a lower risk of late diagnosis compared to those with lower education. Cases diagnosed and treated in health micro-regions other than their home had more late diagnoses and a greater worsening of GIF, while those diagnosed in the same micro-region had a greater recovery. Health micro-regions of residence “high” in detection had more early diagnoses, while “low” micro-regions had a higher rate of immediate treatment initiation. The “hyperendemic” and “very high” regions had a higher proportion of late diagnosis. In terms of disability control, the “very high” micro-regions showed a greater chance of ‘improvement’ and a lower risk of “worsening”. Primary care was associated with a greater chance of early diagnosis, while secondary and tertiary care showed more late diagnoses. Immediate treatment was more effective in secondary and tertiary care, while primary care had better control of disabilities. Tertiary care, on the other hand, performed worse in terms of functional recovery. Conclusion: There are challenges in the effectiveness of the RAS/MG for the early detection of leprosy and equitable access to treatment. Despite the improvement in disability control, inequalities persist between points of care and health micro-regions. Strengthening primary care as the coordinator of the RAS/MG, decentralizing services and training professionals are essential strategies for optimizing the response to the disease.