Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

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Limirio Souza, Ludmilla Leidianne ^[1] ; Dos Santos, Felipe Lima ^[1] ; Crispim, Juliane de Almeida ^[2] ; Fiorati, Regina Celia ^[3] ; Dias, Sonia ^[4] ; Inomata Bruce, Alexandre Tadashi ^[1] ; Alves, Yan Mathias ^[5] ; Vieira Ramos, Antonio Carlos ^[5] ; Berra, Thais Zamboni ^[5] ; Paulino da Costa, Fernanda Bruzadelli ^[5] ; Alves, Luana Seles ^[5] ; Monroe, Aline Aparecida ^[1] ; Fronteira, Ines ^[6] ; Arcencio, Ricardo Alexandre ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo Ribeirao Preto, Publ Hlth Nursing Grad Program, Coll Nursing, Ave Bandeirantes, BR-3900 Ribeirao Preto, SP - Brazil

^[2] Univ Sao Paulo Ribeirao Preto, Interinst Doctoral Program Nursing, Coll Nursing, Ribeirao Preto, SP - Brazil

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

^[4] Univ Nova Lisboa, Natl Sch Publ Hlth, Lisbon - Portugal

^[5] Univ Sao Paulo Ribeirao Preto, Publ Hlth Nursing Grad Program, Coll Nursing, Sao Paulo, SP - Brazil

^[6] Univ Nova Lisboa, Inst Higiene & Med Trop, Global Hlth & Trop Med, Lisbon - Portugal

• Tipo de documento: Artigo Científico
• Fonte: BMC HEALTH SERVICES RESEARCH; v. 21, n. 1 OCT 1 2021.
• Citações Web of Science: 0

Resumo

Background Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. Methods We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of Sao Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework. Results The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. Conclusion The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment. (AU)

• Processo FAPESP: 18/14337-0 - Estudo misto dos determinantes da tuberculose multidroga-resistente no estado de São Paulo: Da abordagem bayesiana à percepção dos profissionais de saúde e pacientes
• Beneficiário: Ricardo Alexandre Arcêncio
• Modalidade de apoio: Auxílio à Pesquisa - Regular