State Program Implementation Evaluation of Prevention and Control of Viral Hepatitis (PEHV) in São Paulo using the laboratory component as tracer

Abstract

 The recognition of the problem of viral hepatitis, while health problem and their individual and collective     consequences date back centuries, however the identification of causative agents is relatively recent,     the first to be identified was the hepatitis B virus in 1965, and other later. While public health problem     worldwide and in Brazil, WHO estimates and MS already pointed million infected and thousands of     cases of illness and deaths since the 1980s. Over the past 30 years, significant progress has been made,     regarding the prevention, control, development of laboratory tests, vacines and therapeutic drugs. The     Health Department of São Paulo State, recognizing the importance of viral hepatitis in the context of     Brazilian public health, launched in 2001, the State Program for Prevention and Control of Viral Hepatitis.     This program is, by placing a synthetic form, the following objectives: Increase the detection of patients     with viral hepatitis, reduce the appearance of new cases, and reduce the mortality rate from chronic viral     hepatitis serotypes B and C. The objective of this study is to evaluate the implementation process of the     diagnosis and its network components of PEHV - Serology; Biopsy and Molecular Biology. The latter     component is of particular importance due to the technological development process. Evaluative questions     were: 1. The PEHV implemented its componente laboratory diagnosis. 2. Interventions are achieving     some effect on the diagnostic network. – Immediate goal. 3. The effects on the network diagnostic     influenced the other program components, specifically Epidemiological Surveillance and Assistance.     – Does it possible to identify which part of the intervention goal was responsible for mediate results?     4. Which Factors are associated with these effects? This evaluative research, due to the complexity of     the program used an approach by “Triangulation Method” - Documentary analysis, interviews with key     actors in the process and analysis of historical series of indicators using the laboratory diagnosis as     “Tracer” for PEHV. For analysis of the time, series used the methodology of “interrupted time series”     with multivariate regression. The results allow the following conclusions: 1. The PEHV implemented its     component laboratory diagnosis of clear and consistent manner. Interventions effectively exerted influence     on laboratory indicators. 2. The diagnostic performance of network influences the other components of     the program, the increase in serology tests corresponds to an increase in notifications and increases     development of molecular biology corresponds to the increase in access to treatment. 3. Although some     interventions may appear to have a greater influence in the observed effects, it is not possible to establish     a specific and individualized causation of these interventions in these effects. 4. The figure of the “tracer”,     proved useful in conducting analyzes, however, in our view, the indicators laboratory should not be used     alone for such evaluations. 5. Coverage of liver biopsy proved to be a critical point of PEHV, and requires     specific actions for addressing them. 6. The strategy of search patients with viral hepatitis by increasing     the availability of serological tests should be revised in order to increase their efficiency.