Determinants related to illness and treatment outcomes for multidrug-resistant tuberculosis in the state of São Paulo

Author(s)

Luiz Henrique Arroyo

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Escola de Enfermagem (EE/SBD)
• Defense date: 2020-08-03

Examining board members

Ricardo Alexandre Arcêncio; Valdes Roberto Bollela; Dulce Maria de Oliveira Gomes; Elias Teixeira Krainski

• Advisor: Ricardo Alexandre Arcêncio

Abstract

Multidrug-resistant tuberculosis is a threat to efforts to eliminate tuberculosis globally, causing significant impacts on the health of populations and burdening health systems. Few studies have sought to understand the determinants associated with illness and treatment outcomes for this disease, which is an important gap to support measures for the prevention and control of the disease. This thesis is presented in the format of two published articles, and its objectives were to identify the determinants associated with unfavorable treatment outcomes and those related to individuals\' illnesses due to multidrug-resistant tuberculosis. The study presented a retrospective cohort design and was conducted in the 645 municipalities in the state of São Paulo. All notifications of cases of sensitive and multidrug-resistant tuberculosis registered in the state system of notifications of tuberculosis cases (TBWeb) between the years 2006 to 2016 were collected. For the first article, which verified the factors related to the unfavorable treatment outcomes, binary logistic regression was employed. In the case of the second article, the determinants of illness were identified from the Bayesian Hierarchical Spatial Analysis with a multilevel design. The first article showed that using illicit drugs and the diagnosis in urgency/emergency units was related to worse treatment outcomes. The second article showed that determinants associated with the individual\'s clinical-operational characteristics, socioeconomic conditions and access to health services resulted in a greater chance of becoming ill with multidrug-resistant tuberculosis. The knowledge of the predictors for the treatment outcome and for the population\'s illness can help the development of strategies and actions for control, disease prevention and patient-centered care, avoiding people\'s suffering and the expansion of resistant cases. (AU)

• FAPESP's process: 17/11040-4 - Determinants of drug-resistant Tuberculosis in the State of São Paulo: an approach with R-INLA
• Grantee: Luiz Henrique Arroyo
• Support Opportunities: Scholarships in Brazil - Doctorate