Análise da completude do tratamento preventivo da tuberculose no Brasil
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Data
2023-08-18
Autores
Cola, João Paulo
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Universidade Federal do Espírito Santo
Resumo
The completeness of the preventive treatment for tuberculosis (PTT) is still a challenge to be faced, due to the social, economic and clinical factors of the affected population and the long therapeutic regimens or those with high doses of medication. It was intended to discuss in this thesis the challenges involved in completing the TPT and to bring new opportunities to the TPT in Brazil with the incorporation of Isoniazid in the 300mg presentation. Objective: To analyze the preventive treatment of tuberculosis in Brazil. Methods: To carry out this study, 2 execution stages were adopted. The first step was a retrospective cohort study based on secondary TPT data reported to the Brazilian IL-TB information system. Individuals who started TPT between January 2018 and December 2020 were included. The outcome was non-completion of the TPT. A robust variance Poisson regression model was used to estimate the relative risk of non-completion of the TPT. The second stage is a pragmatic, randomized, non-blinded clinical trial to determine the completeness of the TPT with the drug Isoniazid in the presentation of a 300mg tablet. The study intervention was the treatment of ITB with Isoniazid 300mg. The primary outcome was TPT completeness. A robust variance Poisson regression model was used to estimate the relative risk of TPT completion with Isoniazid 300mg. Results: Of the 39,973 TPT reported during the study period, 8,534 (21.5%) did not complete the TPT. Age 15–60 years (RR 1.27, 95% CI 1.20–1.35), TPT with isoniazid (RR 1.40, 95% CI 1.19–1.64), and black race/skin color (RR 1.17, 95% CI 1.09–1.25) were associated with a higher risk of non-completion of the TPT. The risk of completing the TPT was 31 times greater in the group that used the INH 300mg treatment (RR 1.31, 95% CI 1.01 to 1.70). The mean effect of TPT with INH 300mg, based on propensity score weighting, describes that TPT with INH 300mg improved 16% (Coefficient 0.16, 95%CI 0.01 to 0.30) treatment completion rate. Conclusion: Individuals of black race/skin color, younger and on a longer TPT regimen, were more likely to be associated with non-completion of the TPT. The therapeutic regimen with isoniazid 300mg presented greater TPT completeness. This study supports theoretical and operational strategies that respond to the demand for the incorporation of a new drug formulation for the treatment of ITB in the Unified Health System network.
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Palavras-chave
Tuberculose latente , Mycobacterium tuberculosis , Isoniazida , Quimioprevenção , Ensaio clínico , Coorte retrospectiva