Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Factors associated with the rapid implementation process of the fixed-dose combination RHZE tuberculosis regimen in brazil: an ecological study

Authors: José Ueleres Braga, Deborah Araújo da Conceição, Anete Trajman

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

The Brazilian National Tuberculosis Control Program (NTCP) recommended the fixed-dose four-drug combination (FDC-RHZE) regimen to treat new tuberculosis cases in December 2009, expecting to increase adherence and avoid resistance. We evaluated factors associated with the speed of the new regimen implementation process in this continent-sized country.

Methods

We conducted an ecological study based on the Brazilian Case Notification Database (SINAN) having the Brazilian municipalities as the analytical unit. Municipalities with at least one case reported from December 2009 to March 2011 were considered eligible. The association of rapid (≤ 3 months) implementation of the new regimen with demographic, epidemiological and operational health service characteristics, such as compliance with NTCP recommendations (supervised treatment, bacteriological confirmation of the diagnosis and monthly bacteriological monitoring), was analyzed. We used the adjusted odds ratios (OR) and their 95% confidence interval (CI) to assess the association of independent variables with the outcome in a multiple logistic regression model.

Results

Rapid implementation of the new regimen in municipalities was associated with small populations (OR=25.5, 95% CI= 19.1-34.1), low population density (OR=2.3, 95% CI= 1.9–2.9), low tuberculosis incidence rates (OR=8.8, 95% CI= 6.7–11.4) and good compliance with other NTCP recommendations.

Conclusions

We showed that SINAN secondary data analysis is feasible and useful to learn lessons from. Municipalities with high tuberculosis burden and large populations need special attention for implementing new recommendations. This is particularly important considering the Global Alliance pipeline for new tuberculosis treatment regimens.
Literature
1.
Brasil: Manual de recomendações para o controle da tuberculose no Brasil. 2011, Brasília: Ministério da Saúde
2.
Gazetta CE, Vendramini SH, Ruffino-Netto A, Oliveira MR, Villa TC: Descriptive study of the implementation and impact of the directly observed treatment, short-course strategy in the Sao Jose do Rio Preto municipal tuberculosis control program (1998–2003). J Bras Pneumol. 2007, 33 (2): 192-198. 10.1590/S1806-37132007000200014.CrossRefPubMed
3.
Gerald LB, Bruce F, Brooks CM, Brook N, Kimerling ME, Windsor RA: Standardizing contact investigation protocols. Int J Tuberc Lung Dis. 2003, 7 (12 Suppl 3): S369-S374.PubMedPubMedCentral
4.
5.
Brasil: Nota técnica sobre as mudanças no tratamento da tuberculose no Brasil para adultos e adolescentes. Norma técnica. 2009, Brasília: Ministério da Saúde/ Secretaria de Vigilância em Saúde/ Departamento de Vigilância Epidemiologica/ Programa Nacional de Controle da Tuberculose
6.
WHO: Global tuberculosis control: WHO report 2011. 2012, Geneve: World Health Organization, Report No.: WHO/HTM/TB/2011.16
7.
Braga J, Conceição D, Schlussel M, Loureiro R: Relatório técnico - Estudo da efetividade e da aceitabilidade do tratamento da tuberculose com o esquema 4 em 1 DFC (Dose Fixa Combinada). 2011, CEPESC - UERJ: Rio de Janeiro
8.
Felisberto E, Carvalho EF, Maggi RS, Samico I: Avaliação do processo de implantação da estratégia da Atenção Integrada às doenças prevalentes da infância no Programa Saúde da Família, no estado de Pernambuco, Brasil. Cadernos de saude publica / Ministerio da Saude, Fundacao Oswaldo Cruz, Escola Nacional de Saude Publica. 2002, 18: 1737-1745. 10.1590/S0102-311X2002000600028.
9.
Felisberto E, Freese E, Alves CKA, Bezerra LCA, Samico I: Política de monitoramento e avaliação da atenção básica no Brasil de 2003 a 2006: contextualizando sua implantação e efeitos. Rev bras saúde matern infant. 2009, 9 (3): 339-357. 10.1590/S1519-38292009000300013.CrossRef
10.
Henrique F, Calvo MCM: Grau de implantação do Programa Saúde da Família e indicadores sociais. Cienc Saude Coletiva. 2009, 14 (sup 1): 1359-1365.
11.
Nagahama EEI: Avaliação da implantação de serviços de saúde reprodutiva no Município de Maringá, Paraná. Brasil Cad saúde pública. 2009, 25 (Sup 2): S279-S290.PubMed
12.
Quinino LRM, Costa JMBS, Aguiar LR, Wanderley TNG, Barbosa CS: Avaliação das atividades de rotina do Programa de Controle da Esquistossomose em municípios da Região Metropolitana do Recife, Pernambuco, entre 2003 e 2005. Epidemiologia e Serviços de Saúde. 2009, 18 (4): 335-343.
13.
de Sa LD, de Andrade MN, Nogueira Jde A, Villa TC, de Figueiredo TM, de Queiroga RP: Implantacao da estrategia DOTS no controle da Tuberculose na Paraiba: entre o compromisso politico e o envolvimento das equipes do programa saude da familia (1999–2004). [Implementation of the DOTS strategy in the control of TB in Paraiba: between the political commitment and the involvement of the teams of the family health program (1999–2004)]. Cien Saude Colet. 2011, 16 (9): 3917-3924. 10.1590/S1413-81232011001000028.CrossRefPubMed
14.
StataCorp LP: Stata graphics reference manual: release 10 College Station. 2007, StataCorp LP: Texas, (College Station is a city in Brazos County, Texas)
15.
Cobelens F, van den Hof S, Pai M, Squire SB, Ramsay A, Kimerling ME: Which new diagnostics for tuberculosis, and when?. The Journal of infectious diseases. 2012, 205 (Suppl 2): S191-198. 10.1093/infdis/jis188.CrossRefPubMed
16.
Gardner CA, Acharya T, Pablos-Méndez A: The global alliance for tuberculosis drug development--accomplishments and future directions.  . 2005, 26 (2): 341-
17.
Kaufmann SHE, Hussey G, Lambert PH: New vaccines for tuberculosis. Lancet. 2010, 375 (9731): 2110-2119. 10.1016/S0140-6736(10)60393-5.CrossRefPubMed
18.
Habicht JP, Victora CG, Vaughan JP: Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol. 1999, 28 (1): 10-18. 10.1093/ije/28.1.10.CrossRefPubMed
19.
Elmahalli AA, Abdel-Aziz BF: Assessment of the implementation of DOTS strategy in two chest facilities in Alexandria, Egypt. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2007, 13 (5): 1085-97.
20.
Furin J, Bayona J, Becerra M, Farmer P, Golubkov A, Hurtado R: Programmatic management of multidrug-resistant tuberculosis: models from three countries. Int J Tuberc Lung Dis. 2011, 15 (10): 1294-300. 10.5588/ijtld.10.0591.CrossRefPubMed
21.
Bezerra LC, Freese E, Frias PG, Samico I, Almeida CK: Epidemiological surveillance at the municipal level: evaluation of the degree of implementation. Cad Saude Publica. 2009, 25 (4): 827-839. 10.1590/S0102-311X2009000400014.CrossRefPubMed
22.
Nogueira JdA, Ruffino-Netto A, Villa TCS, Monroe AA, Lucca MES: Implantação da estratégia DOTS no controle da tuberculose em Ribeirão Preto, São Paulo (1998-2004). Boletim de Pneumologia Sanitária. 2006, 14 (3): 141-144.
Metadata
Title
Factors associated with the rapid implementation process of the fixed-dose combination RHZE tuberculosis regimen in brazil: an ecological study
Authors
José Ueleres Braga
Deborah Araújo da Conceição
Anete Trajman
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-321

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue

Research article

Serum γ-glutamyltransferase and uric acid levels are associated with impaired fasting glucose in adults from Inner Mongolia, China

Research article

Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial

Research article

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India

Research article

Canadian adolescent perceptions and knowledge about the social determinants of health: an observational study of Kingston, Ontario youth

Research article

Associations between oral health-related impacts and rate of weight gain after extraction of pulpally involved teeth in underweight preschool Filipino children

Research article

Sexually transmitted infections among HIV-infected women in Thailand