TY - JOUR
T1 - Determinants of multidrug-resistant tuberculosis in São Paulo-Brazil
T2 - a multilevel Bayesian analysis of factors associated with individual, community and access to health services
AU - Arroyo, Luiz Henrique
AU - Yamamura, Mellina
AU - Ramos, Antônio Carlos Vieira
AU - Campoy, Laura Terenciani
AU - Crispim, Juliane de Almeida
AU - Berra, Thais Zamboni
AU - Alves, Luana Seles
AU - Alves, Yan Mathias
AU - Dos Santos, Felipe Lima
AU - Souza, Ludmilla Leidianne Limirio
AU - Bruce, Alexandre Tadashi Inomata
AU - de Andrade, Hamilton Leandro Pinto
AU - Bollela, Valdes Roberto
AU - Krainski, Elias Teixeira
AU - Nunes, Carla
AU - Arcêncio, Ricardo Alexandre
N1 - © 2020 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR-TB.METHODS: Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out.RESULTS: It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06-15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44-6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87-2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91-3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44-2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14-1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10-1.46) were associated with MDR-TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25-1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17-1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30-1.87) were also related to the MDR-TB.CONCLUSIONS: Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR-TB, avoiding the risks expressed regarding drug resistance expansion.
AB - OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR-TB.METHODS: Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out.RESULTS: It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06-15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44-6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87-2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91-3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44-2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14-1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10-1.46) were associated with MDR-TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25-1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17-1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30-1.87) were also related to the MDR-TB.CONCLUSIONS: Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR-TB, avoiding the risks expressed regarding drug resistance expansion.
KW - access
KW - and evaluation
KW - communicable disease control
KW - health care quality
KW - multidrug-resistant tuberculosis
KW - risk factors
KW - socioeconomic factors
UR - http://www.scopus.com/inward/record.url?scp=85085558667&partnerID=8YFLogxK
U2 - 10.1111/tmi.13409
DO - 10.1111/tmi.13409
M3 - Article
C2 - 32358845
SN - 1360-2276
VL - 25
SP - 839
EP - 849
JO - Tropical Medicine & International Health
JF - Tropical Medicine & International Health
IS - 7
ER -
