Spatial analysis of the cure rate for tuberculosis in primary health care in the municipality of Rio de Janeiro between 2012 and 2014

Abstract

BackgroundTuberculosis (TB) has a high disease burden and the World Health Organization (WHO) states it is a global emergency. TB is the most important cause of death from infectious disease in adults. It is directly related to access to health services and socioeconomic factors. Primary health care (PHC) provides greater linkage of people to health services and greater medication adherence in some chronic diseases. It also provides supervised treatment and more effective search for contactants. The PHC Reform started in 2009 in Rio de Janeiro, increasing coverage from 7% to 46.16% in 2015.Methodology/Principal findingsThis paper aims to evaluate the spatial distribution of new TB cases closed with a cure outcome in dwellers of Rio de Janeiro in the period 2012-2014, according to PHC coverage, controlling socioeconomic, demographic and epidemiological factors. Variables were obtained from the Notifiable Diseases Information System for Tuberculosis (SINAN-TB) and the socioeconomic variables from the 2010 national census at census tract level. The socioeconomic variables were selected from multivariate analysis using main factors analysis technique. The generalized additive model (GAM) was used for the spatial analysis. Association was found between TB cure and variables education, alcoholism, contacts search, HIV serology and elderly. People with family health coverage between 35 and 41 months were 1.64 more likely of cure when compared to people without coverage (95% CI 1.07-2.51). Spatial analysis identified areas with less probability of cure for tuberculosis in the municipality of Rio de Janeiro.Author SummaryTuberculosis is associated to social and demographic conditions. Lack of access to healthcare contributes to delay in diagnosis and in the beginning of the treatment. Primary health care improve access and adherence to treatment. This study can be useful as a public health policy, since it is possible to prioritize the region in the map to improve TB cure. We found association between tuberculosis cure and the duration of implantation of the primary health care teams. This finding corroborates the importance of treating tuberculosis in this level of care. The spatial analysis of cases of tuberculosis cure showed a significant spatial association with the cure of tuberculosis. The results of this study can contribute reinforcing the policy makers for developing primary health care to improve the access to health services and to reach better TB cure rates. Spatial analysis may be an useful tool for identifying the areas where to prioritize efforts for reaching better results.