Determinants of multidrug‐resistant tuberculosis in São Paulo—Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services

Abstract

Objective Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB. Methods Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out. Results It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06–15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44–6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87–2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91–3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44–2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14–1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10–1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25–1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17–1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30–1.87) were also related to the MDR‐TB. Conclusions Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

“…In Brazil, in 2020, adherence, expressed by successful treatment, was much lower that the goals recommend by the WHO, accounting for 71% in reality when the expected was more than 85% among the sensible cases [2]. The cases where MDR-TB was observed were dramatic, with successful treatment ranging from 40 to 60% [10]. It can be become more complex, since there is evidence there was a decrease of 16% in the notification of new TB cases in 2020 as compared to 2019.…”

“…The study was conducted in Ribeirão Preto, which is located in the interior of the state of São Paulo, Brazil. The choice of the scenario is justified, because it is a reference municipality in the treatment and monitoring of MDR-TB and classified as high risk [10]. For the treatment of MDR-TB cases, we have the Clinics Hospital of the Ribeirão Preto Medical School at the University of São Paulo (HCFMRP-USP) in the city and the additional support of the reference center in specialties.…”

“…TB in the city under study has an incidence of 26.45 cases for every 100,000 inhabitants, 9.3% of patients with abandonment of treatment, and 63% of the proportion of new cases of pulmonary TB undergoing DOT. When it comes to coverage of primary health care, the municipality has a rate of 63.9%, and as for the coverage of the family health strategy, the index has only 21.5%, being an important predictor of MDR-TB [10].…”

Multidrug-resistant tuberculosis from the health providers’ perspective: strategies for compliance and equity in seeking the care in COVID-19 era (Brazil, 2020)

“…The study was conducted in Ribeirão Preto, located in the interior of the state of São Paulo, Brazil. The choice of the scenario is justi ed because it is a reference municipality in the treatment and monitoring of MDR-TB and classi ed as high risk [21]. For the treatment of MDR-TB cases, we have the Hospital das Clínicas of the Ribeirão Preto Medical School (HCFMRP) in the city and the support of the Reference Center in Specialties, in addition, the monitoring of these patients is performed through home visits proposed by the Directly Observed Treatment (DOT).…”

Patients’ perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study

“…It is important to highlight the determinants of MDR-TB due to the consequences of this form of disease on people with TB, who are subjected to expensive (to both the health system and patients), extensive, complex, and stigmatizing treatments and the use of drugs with high toxic potential that consequently lead to a worse prognosis and exorbitant investments in the public health system [ 7 , 8 ].…”