O controle da tuberculose em instituições prisionais paulistas: um estudo de métodos mistos

Abstract

LIMA, M.C.R.A.A. Tuberculosis control in São Paulo´s state prisons system: an mixed methods study. 2018. 132p. Thesis (Doctorate Degree) -Ribeirão Preto College of Nursing -University of São Paulo, 2018.The overall objective of the study was to analyze the control of tuberculosis in penitentiaries. Method: explanatory sequential mixed study. In step 1, a quantitative approach, the scenario corresponds to the prison units of São Paulo, and step 2, a qualitative approach, corresponds to the Iperó penitentiary.Step 1 was a descriptive study using data regarding the cases of prisoners notified with tuberculosis in the period 2010-2016, collected from the secondary source TBweb. Descriptive analyzes were performed in SPSS 20.0 software, Statistica 13.0 from Statsoft and time trend analysis was performed on the Stata / SE 14.0 software considering the Prais-Winsten self-regression method. In step 2, data were generated by semi-directed interviews to eight health professionals selected who performed the actions for the management of tuberculosis in the penitentiary for more than six months. The interviews were audio-taped. For data analysis, procedures of the Constructivist Grounded Theory were used. This study was approved by the Research Ethics Committees of the Ribeirão Preto College of Nursing -University of São Paulo and the Secretariat of Penitentiary Administration of the state of São Paulo. The results indicated that 16,640 cases of tuberculosis were reported in the period, which vast majority of males. The new cases represented 79% of the total. The cases were mostly pulmonary (95.8%), 67.8% of which were bacilliferous. The alcohol and drugs' use showed increased trends. Ambulatory Demand was responsible for the diagnosis of 51.4% of cases and Active Case Finding for 31.2%. Treatment default and nontuberculosis death presented decreasing trends. Health professionals perceive that in order to control the disease, they must "Do my job well", which was the main category, that was divided into two others: 1) Discovering the disease: perceiving the prisoners who get ill and the signs and symptoms of those who they do not want to be discovered; moreover, have to investigating the manifestation of the symptoms reported by the prisoners in order to verify the presence or not of the disease; 2) Involvement in the treatment of the disease: they put effort to cure the ill prisoner, give them orientation in order to complete all the treatment, even if this also involves persuading them and / or to coerced them. It is considered that due to the significant presence of the pulmonary form, a cycle of strategies of detection of the disease is made urgent, as well as greater attention the accomplishment and finalization of the treatment. Even if the guidelines are well established, it is not always possible to operationalize. Despite the difficulties faced in the care process, the health professionals do not spare efforts for the management of tuberculosis.