Public and private health network integration as instrument for the organization of serologic diagnosis for american visceral leishmania in Minas Gerais

Abstract

 The State Secretary ofHealth ofMinas Gerais notified to theMinistry ofHealth the highest number of American visceral leishmaniasis – LVA – patients from 2004 to 2006 in Brazil. From2000 to 2006, 2.727 human cases were confirmed, with 246 deaths and average lethality of 9,0%1. LVA control establishes the following guidelines: epidemiologic surveillance actions, diagnosis and euthanasia of seroreactive dogs and specific entomologic measures. Among the impairments identified in the performance of such actions, the serologic diagnosis of canine LVA presented amajor bias. Private laboratories employed the Elisa kit registered at the Ministry of Agriculture, Husbandry and Supplies but not validated by the Ministry ofHealth as a triage and confirmation test. The public network employed kits produced by the Laboratories Fiocruz/Biomanguinhos/Fiocruz: Elisa as a triage and indirect immunoflorescence reaction (RIF) as confirmation. This study regarded: organization of public and private serologic diagnosis services for canine LVA in Minas Gerais, achieving: integration of responsible institutions, supervisions, upgrading, conduct adjustment, guidelines to unify requisitions and results forms; implantation of RIF as confirmation in the private network, by force of the Resolution 324/CRMV-MG; reduction of the divergence between private and public laboratories results; diminishing the complaints of consumers and professionals, higher control of the exams by the Lacen-MG; implantation of criteria for the authorization of private laboratories; inhibition of the offer of diagnosis services performed with kits with no register in the MAPA and knowledge of the positive indexes of canine LVA in the private network. Organization of the serologic diagnosis for canine LVA induced higher trust, reduced the interference over the surveillance services and in the effectiveness of LVAcontrols actions.