Factors associated with the rapid implementation process of the fixed-dose combination RHZE tuberculosis regimen in brazil: an ecological study
Factors associated with the rapid implementation process of the fixed-dose combination RHZE tuberculosis regimen in brazil: an ecological study
Data
2013
Autores
Braga, José Ueleres
Conceição, Deborah Araújo da
Trajman, Anete
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Resumo
Background: The Brazilian National Tuberculosis Control Program (NTCP) recommended the fixed-dose four-drug
combination (FDC-RHZE) regimen to treat new tuberculosis cases in December 2009, expecting to increase
adherence and avoid resistance. We evaluated factors associated with the speed of the new regimen
implementation process in this continent-sized country.
Methods: We conducted an ecological study based on the Brazilian Case Notification Database (SINAN) having the
Brazilian municipalities as the analytical unit. Municipalities with at least one case reported from December 2009 to
March 2011 were considered eligible. The association of rapid (≤ 3 months) implementation of the new regimen
with demographic, epidemiological and operational health service characteristics, such as compliance with NTCP
recommendations (supervised treatment, bacteriological confirmation of the diagnosis and monthly bacteriological
monitoring), was analyzed. We used the adjusted odds ratios (OR) and their 95% confidence interval (CI) to assess
the association of independent variables with the outcome in a multiple logistic regression model.
Results: Rapid implementation of the new regimen in municipalities was associated with small populations
(OR=25.5, 95% CI= 19.1-34.1), low population density (OR=2.3, 95% CI= 1.9–2.9), low tuberculosis incidence rates
(OR=8.8, 95% CI= 6.7–11.4) and good compliance with other NTCP recommendations.
Conclusions: We showed that SINAN secondary data analysis is feasible and useful to learn lessons from.
Municipalities with high tuberculosis burden and large populations need special attention for implementing new
recommendations. This is particularly important considering the Global Alliance pipeline for new tuberculosis
treatment regimens.
Description
Palavras-chave
Tuberculosis, Drug combinations, Health plan implementation, Epidemiology, Public health.
Citação
Braga JU, da Conceição DA, Trajman A. Factors associated with the rapid implementation process of the fixed-dose combination RHZE tuberculosis regimen in Brazil: an ecological study. BMC Public Health. 2013 Apr 9;13:321. doi: 10.1186/1471-2458-13-321.