Multiple Treatments for Tuberculosis in the Central Area of a Metropolis, 2008-2016: Profiles, Causes and Characteristics

Abstract

Introduction: Tuberculosis still afflicts millions worldwide, with a
considerable number of cases in Brazil, mainly in the central region of the city
of São Paulo. A significant proportion of patients needs more than a single
course of treatment, demanding a better understanding about the causes and
consequences of these retreatments. Objective: To study the demographic,
epidemiological and clinical characteristics of patients with more than one
treatment for tuberculosis notified between 2008 and 2016, in the Central Region
of São Paulo Municipality. Methods: Cross-sectional epidemiological study
with secondary data obtained from TBWeb system of São Paulo State Health
Department. Inclusion criteria: those reported and treated as a tuberculosis case
in the central region of São Paulo City at least twice between 2008 and 2016.
Demographic, epidemiological and clinical data were analyzed with SPSS
21.0. Results: Among 4105 patients with tuberculosis in the central region of
São Paulo, occurred 570 retreatments in 249 patients. Of 249 patients 72.3%
were male, mean age 37.2±14 years old, being 113 HIV+. The most common
reasons for retreatment were: abandonment of previous treatment (59.4%),
relapse (28.1%), and treatment failure (10%). Forty-five patients (37.5% of
those tested) presented some degree of drug resistance. The outcomes of 249
patients were: cure (46.5%), abandonment (26.5%), and death (12%). HIV+
status and previous abandonment were associated with the worse outcomes.
Retreatment due to the previous treatment failure was associated with cure.
Conclusion: Multiples profiles occur in patients with many treatments in the
studied area. They are the heterogeneous group, with different needs to be met
by the health system.