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. 2018 Apr 25;18(1):554.
doi: 10.1186/s12889-018-5468-8.

Performance of centralized versus decentralized tuberculosis treatment services in Southern Brazil, 2006-2015

Mara Cristina Scheffer  1 , Rodrigo Ivan Prim  1 , Leticia Muraro Wildner  1 , Taiane Freitas Medeiros  1 , Rosemeri Maurici  2 , Emil Kupek  3 , Maria Luiza Bazzo  4   5
Affiliations

Performance of centralized versus decentralized tuberculosis treatment services in Southern Brazil, 2006-2015

Mara Cristina Scheffer et al. BMC Public Health. .

Abstract

Background: Tuberculosis (TB) control programs face the challenges of decreasing incidence, mortality rates, and drug resistance while increasing treatment adherence. The Brazilian TB control program recommended the decentralization of patient care as a strategy for combating the disease. This study evaluated the performance of this policy in an area with high default rates, comparing epidemiological and operational indicators between two similar municipalities.

Methods: This study analyzed epidemiological and operational indicators on new cases of pulmonary tuberculosis reported in the Brazilian Notifiable Diseases Information System between 2006 and 2015. In addition, to characterize differences between the populations of the two studied municipalities, a prospective cohort study was conducted between 2014 and 2015, in which patients with new cases of culture-confirmed pulmonary tuberculosis were interviewed and monitored until the disease outcome. A descriptive analysis, the chi-square test, and a Poisson regression model were employed to compare TB treatment outcomes and health care indicators between the municipalities.

Results: Two thousand three hundred nine cases were evaluated, of which 207 patients were interviewed. Over the 2006-2015 period, TB incidence per 100,000 population in the municipality with decentralized care was significantly higher (39%, 95% CI 27-49%) in comparison to that of the municipality with centralized care. TB treatment default rate (45%, 95% CI 12-90%) was also higher in the municipality with decentralized care. During the two-year follow-up, significant differences were found between patients in centralized care and those in decentralized care regarding treatment success (84.5 vs. 66.1%), treatment default (10.7 vs. 25.8%), illicit drug use (27.7 vs. 45.9%), and homelessness (3.6 vs. 12.9%). The operational indicators revealed that the proportion of control smear tests, medical imaging, and HIV tests were all significantly higher in the centralized care. However, a significantly higher proportion of patients started treatment in the early stages of the disease in the municipality with decentralized care.

Conclusions: These data showed a low success rate in TB treatment in both municipalities. Decentralization of TB care, alone, did not improve the main epidemiological and operational indicators related to disease control when compared to centralized care. Full implementation of strategies already recommended is needed to improve TB treatment success rates.

Keywords: Decentralized; Public health; Treatment outcome; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved and consented by the Human Health Research Ethics Committee of Federal University of Santa Catarina. Certificate of Presentation for Ethical Consideration: 25716113.7.0000.0121. Administrative permissions were received for accessing medical records or databases in this study. All informants provided written informed consent using approved form by ethics committee, respondents under the age of eighteen, we additionally asked their parent/guardian for written informed consent. We guaranteed the anonymity and confidentiality of the given information by replacing patient names with numbers throughout the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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