Influência da vigilância ativa dos contatos na cascata de cuidado da tuberculose latente

Abstract

Eliminating tuberculosis as a public health problem is necessary and possible, but it has faced operational and other challenges in healthcare services and public policies. One of the strategies to eliminate the disease, which currently has low coverage in the city of Teresina-PI, is the treatment of Latent M. tuberculosis Infection (LTBI). To help with this, an alternative model for monitoring and tracking the Latent Tuberculosis Care Cascade (LTCC) was proposed and tested, aiming to increase healthcare coverage for LTBI. Through a longitudinal intervention study, a controlled, paired, and randomized operational trial was conducted. Fifty-two contacts of laboratory-confirmed bacilliferous tuberculosis cases from 11 Primary Health Care Units (PHUs) in Teresina - Piauí were followed using this alternative model, which consisted of standardized guidance recorded in the Citizen’s Electronic Health Record (PEC) in real time for each of the steps of CCTL. In 11 other UBS in the same health region, the conventional surveillance model was maintained over 27 contacts. In the 22 UBS, demographic data of these contacts and a set of care coverage indicators at each step of CCTL were collected. The indicators collected in the group of UBS where the new surveillance strategy was applied were statistically compared to the same indicators in the group of UBS where the conventional model was maintained. Of the total people studied, most were female and of black race/color. The average age was 33.5 years. The proportion of contacts who had a chest X-ray, who took the 1st tuberculin test and the 2nd tuberculin test when indicated, who were fully examined and who started preventive tuberculosis treatment was higher in the UBS where the alternative active CCTL surveillance model was applied. A statistically significant difference (p < 0.05) was reached in the indicators: proportion of contacts who underwent chest X-ray, who undergo the 2nd tuberculin test when indicated, and the proportion of contacts fully examined. This result showed that the tested model is effective in helping fight tuberculosis because it significantly increases healthcare coverage for latent TB infection.