Profile and follow-up of patients with tuberculosis in a priority city in Brazil

OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes.METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups.RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively).CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality.

研究目的：分析肺结核病例情况以及直接随访对治疗结局评估的影响。
研究方法：本研究为开放前瞻性队列研究，纳入2008年至2009年巴西东南部米纳斯吉拉斯州茹伊斯迪福拉市通过《法定传染病报告信息系统（Sistema de Informação de Agravos de Notificação，简称SINAN）》上报的504例肺结核病例。将研究对象分为两组：一组为于复诊时接受月度面诊直接随访的患者（287例），另一组为通过本市监测系统间接收集诊疗信息的患者（217例），对比两组的治疗结局发生率。采用卡方检验（Chi-square test）比较百分比差异，检验水准设定为0.05；采用相对危险度（relative risk, RR）评估两组各类治疗结局发生率的差异。
研究结果：直接随访组与间接信息收集组中，治疗中断率分别为18.5%和3.2%，治疗失败率分别为3.8%和0.5%。直接随访组的治疗中断率与治疗失败率均显著高于另一组（p<0.05），对应的相对危险度分别为RR=5.72，95%置信区间[2.65;12.34]，以及RR=8.31，95%置信区间[1.08;63.92]。
研究结论：直接随访组的治疗中断率与治疗失败率更高，且此类病例多数未被疾病报告系统覆盖。因此，需采取有效措施以提升肺结核防控水平与数据质量。