Determinants of multidrug-resistant tuberculosis in Sao Paulo-Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services

Author(s):Show less -

Arroyo, Luiz Henrique ^[1] ; Yamamura, Mellina ^[2] ; Ramos, Antonio Carlos Vieira ^[1] ; Campoy, Laura Terenciani ^[1] ; Crispim, Juliane de Almeida ^[1] ; Berra, Thais Zamboni ^[1] ; Alves, Luana Seles ^[1] ; Alves, Yan Mathias ^[1] ; Santos, Felipe Lima ^[1] ; Souza, Ludmilla Leidianne Limirio ^[1] ; Bruce, Alexandre Tadashi Inomata ^[1] ; de Andrade, Hamilton Leandro Pinto ^[1] ; Bollela, Valdes Roberto ^[3] ; Krainski, Elias Teixeira ^[4] ; Nunes, Carla ^[5] ; Arcencio, Ricardo Alexandre ^[1]

Affiliation

^[1] Univ Sao Paulo, Ribeirao Preto Coll Nursing, Ribeirao Preto - Brazil

^[2] Univ Fed Sao Carlos, Dept Nursing, Sao Carlos - Brazil

^[3] Univ Sao Paulo, Ribeirao Preto Med Sch, Sao Paulo - Brazil

^[4] Univ Fed Parana, Dept Stat, Curitiba, Parana - Brazil

^[5] Nova Univ Lisbon, Natl Sch Publ Hlth, Lisbon - Portugal

• Document type: Journal article
• Source: TROPICAL MEDICINE & INTERNATIONAL HEALTH; v. 25, n. 7 MAY 2020.
• Web of Science Citations: 0

Abstract

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 Sao 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 1/4 and 1/2 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. (AU)

• FAPESP's process: 18/14337-0 - Mixed study of the determinants of multidrug-resistant tuberculosis in the state of São Paulo: From the Bayesian approach to the perception of health professionals and patients
• Grantee: Ricardo Alexandre Arcêncio
• Support Opportunities: Regular Research Grants