ObjectivesTo estimate the burden of tuberculosis (TB) in reported AIDS cases, to compare the characteristics of TB/HIV subjects with those without TB and to evaluate survival with or without TB in Brazil.MethodsThe data source was the linked database between AIDS (2011–2014) and TB (2011–2014) databases from the Notifiable Diseases Information System (SINAN). The sociodemographic, clinical, laboratory results and use of antiretroviral therapy (ART) data were compared by TB occurrence or not. Survival probability was estimated using the Kaplan-Meier method and associated factors were sought using Cox regression.ResultsThe proportion of TB diagnosed from 2011 to 2014 among AIDS cases reported between 2006 and 2014 was 6.3%. Subjects coinfected with TB were predominantly male, older, with lower schooling, with lower CD4 count, higher viral load, and higher proportion of ART initiation than those without TB. 57.5% were diagnosed with HIV before TB, 38.2% as concurrent TB/HIV and 4.3% with TB before HIV. 16,466 reported TB cases were not found in the AIDS database, although registered as HIV-infected in the SINAN TB database between 2011 and 2014. Median survival for PLHIV was 581 days, with 582 for those without TB, significantly higher than 547 for those with TB (log-rank teste, p = 0,001). In the Cox multivariate analysis, male gender [aHR = 1.27 (CI 95% 1.22–1.33)], older age [aHR = 1.020 (CI 95% 1.019–1.022)] and TB coinfection [aHR = 1.97 (CI 95% 1.88–2.07)] were positively associated with adjusted hazard of death, whereas CD4 count 200–499 cells [aHR = 0.21 (CI 95% 0.20–0.22)] and receiving ART [aHR = 0.2 2(CI 95% 0.21–0.23)] reduced the risk of death.ConclusionsHIV-infected subjects should be screened for TB at care entry, to minimize diagnosis and treatment delays when active TB is present or to increase the odds of being offered latent TB infection therapy to prevent TB. On the other hand, TB cases should be promptly tested for HIV. All those will contribute to reduce mortality among people living with AIDS.
Objective: to evaluate the Brazilian Drug-Resistant Tuberculosis Surveillance System (DRTB-SS). Methods: this was an evaluative study, following Centers for Disease Control and Prevention guidelines, using national data from the Special Tuberculosis Treatment Information System (SITETB), and the Notifiable Diseases Information System (SINAN), from 2013 to 2017. Results: average data completeness was 95%
Background Brazil is a signatory to the World Health Organization End TB Strategy and the United Nations Sustainable Development Goals. This study aims to characterize tuberculosis (TB) deaths and TB mortality rates in Brazil for the period 1997–2017. Methods We performed an ecological study based on information for TB deaths between 1997 and 2017 extracted from the Mortality Information System of the Brazilian Ministry of Health. Data included gender, age group and geographic regions. The trends in mortality rates were estimated using Joinpoint regression analysis, which identifies years in which there is a change in slope of the time series by the Monte Carlo permutation. Results Between 1997 and 2017 there were 104 172 recorded TB deaths in Brazil and the mortality rates were higher for men and the elderly. The age-adjusted mortality rate decreased from 4.2 per 100 000 in 1997 to 3.0 per 100 000 in 2003 to 2.0 per 100 000 in 2017. The average percentage reduction from 1997 to 2003 was 6.2% (95% confidence interval [CI] −7.7 to −4.7) per year, while from 2003 to 2017 it was 3.0% (95% CI −3.4 to −2.5) per year, representing a slowdown in the rate of decline. Conclusion The high number of deaths and the slowdown in the decline of mortality rates from TB in Brazil maintain the disease as an important public health concern and an obstacle to reaching goals set by international commitments.
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