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. 2017 Nov-Dec;43(6):437-444.
doi: 10.1590/S1806-37562017000000004.

Evaluation of the impact that the changes in tuberculosis treatment implemented in Brazil in 2009 have had on disease control in the country

[Article in English, Portuguese]
Marcelo Fouad Rabahi  1   2 , José Laerte Rodrigues da Silva Júnior  2   3 , Marcus Barreto Conde  4   5
Affiliations

Evaluation of the impact that the changes in tuberculosis treatment implemented in Brazil in 2009 have had on disease control in the country

[Article in English, Portuguese]
Marcelo Fouad Rabahi et al. J Bras Pneumol. 2017 Nov-Dec.

Abstract
in English, Portuguese

Objective: To analyze the impact that the 2009 changes in tuberculosis treatment in Brazil had on the rates of cure, tuberculosis recurrence, mortality, treatment abandonment, and multidrug-resistant tuberculosis (MDR-TB).

Methods: An ordinary least squares regression model was used in order to perform an interrupted time series analysis of secondary data collected from the Brazilian Tuberculosis Case Registry Database for the period between January of 2003 and December of 2014.

Results: The 2009 changes in tuberculosis treatment in Brazil were found to have no association with reductions in the total number of cases (β = 2.17; 95% CI: -3.80 to 8.14; p = 0.47) and in the number of new cases (β = -0.97; 95% CI: -5.89 to 3.94; p = 0.70), as well as having no association with treatment abandonment rates (β = 0.40; 95% CI: -1.12 to 1.93; p = 0.60). The changes in tuberculosis treatment also showed a trend toward an association with decreased cure rates (β = -4.14; 95% CI: -8.63 to 0.34; p = 0.07), as well as an association with increased mortality from pulmonary tuberculosis (β = 0.77; 95% CI: 0.16 to 1.38; p = 0.01). Although there was a significant increase in MDR-TB before and after the changes (p < 0.0001), there was no association between the intervention (i.e., the changes in tuberculosis treatment) and the increase in MDR-TB cases.

Conclusions: The changes in tuberculosis treatment were unable to contain the decrease in cure rates, the increase in treatment abandonment rates, and the increase in MDR-TB rates, being associated with increased mortality from pulmonary tuberculosis during the study period.Keywords: Tuberculosis, pulmonary/epidemiology; Tuberculosis, pulmonary/drug therapy; Tuberculosis, pulmonary/mortality; Interrupted time series analysis; Drug resistance, multiple; Drug compounding.

Objetivo:: Analisar o impacto das mudanças do tratamento da tuberculose implantadas no Brasil em 2009 no número de casos de cura, de recidiva, de óbitos, de abandono e de tuberculose multirresistente (TBMR).

Métodos:: Foi realizada uma análise de séries temporais interrompida utilizando o modelo de regressão pelo método dos mínimos quadrados ordinários a partir de dados secundários coletados do Sistema de Informação de Agravos de Notificação da Tuberculose entre janeiro de 2003 e dezembro de 2014.

Resultados:: A análise mostrou independência entre as mudanças do tratamento e a redução do número total de casos (β = 2,17; IC95%: −3,80 a 8,14; 189 p = 0,47), a redução do número de novos casos (β = −0,97; IC95%: −5,89 a 3,94; p =190 0,70) e do abandono do tratamento (β = 0,40; IC95%: 199 −1,12 a 1,93; p = 0,60). Demonstrou ainda tendência à associação com a diminuição da cura (β = −4,14; IC95%: −8,63 a 0,34; p = 0,07) e associação com aumento da mortalidade por tuberculose pulmonar (β = 0,77; IC95%: 0,16 a 1,38; p = 0,01). A TBMR aumentou significativamente tanto no período anterior quanto no período posterior às mudanças do tratamento (p < 0,0001), embora de forma independente da intervenção (β = 0,13; IC95%: −0,03 a 0,29; p = 0,12).

Conclusões:: As mudanças no tratamento não impediram nem a diminuição na taxa de cura e nem o aumento do abandono e da TBMR; por outro lado, se associaram ao aumento de óbitos por tuberculose pulmonar durante o período do estudo.

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Figures

Figure 1
Figure 1. Graphical representations of cure, treatmet abandonment, mortality, and multidrug-resistant tuberculosis (MDR-TB) rates in the 2003-2014 period. The vertical axis (ordinate) represents the proportions relative to the total number of cases of pulmonary tuberculosis during the study period. The horizontal axis (abscissa) represents the variable “years”. The dashed rectangle represents the transition from the old to the new tuberculosis treatment in Brazil.
Figure 2
Figure 2. Interrupted time series regressions for the following variables: total number of cases of pulmonary tuberculosis (in A); new cases (in B); cases of cure (in C); cases of treatment abandonment (in D); cases of multidrug-resistant tuberculosis (MDR-TB, in E); total number of deaths (in F); deaths from other causes (in G); and deaths from pulmonary tuberculosis (TB, in H). The dots represent the data collected for each variable each month from January of 2003 to December of 2014, and the straight line represents the data trend. The middle column corresponds to the period in which the intervention was implemented (between December of 2009 and December of 2010). *Statistically significant.
See this image and copyright information in PMC

References

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    1. Conde MB, Melo FA, Marques AM, Cardoso NC, Pinheiro VG, Dalcin Pde T. III Brazilian Thoracic Association Guidelines on tuberculosis. J Bras Pneumol. 2009;35(10):1018–1048. https://doi.org/10.1590/S1806-37132009001000011 - DOI - PubMed
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