Desfecho do tratamento da tuberculose em tempos de pandemia da Covid-19 no centro de referência regional do sul do Brasil

Abstract

The reorientation of public policies, which forced managers to prioritize the fight against the Covid-19 pandemic in view of the possibility of the collapse of the health system, has affected the network of tuberculosis care services, evidenced by the worsening of indicators and can generate serious consequences in the control of the disease. The objective was to analyze the relationship between the profile of people with tuberculosis and health actions with the outcome of treatment at a reference service in the city of Pelotas/RS during the period of the Covid-19 pandemic. Quantitative, descriptive and exploratory study, developed from secondary data obtained from the medical records of people who ended treatment for tuberculosis in the municipal reference service. For data analysis, we proceeded with the distribution of relative and absolute frequencies of qualitative variables and measures of central tendency and variability for quantitative variables, then to test the association between the epidemiological profile of the cases and the outcomes of treatment for tuberculosis, he applied up the chi-square and Fisher's exact test. To compare the means of quantitative variables related to health actions between groups with favorable and unfavorable treatment outcomes, the Mann Whitney test was used. A total of 134 people with tuberculosis attended by the reference service were included, among which 74.6% were discharged due to cure, 19.4% of abandonment of pharmacological treatment and 6% of deaths were recorded, totaling the occurrence of 25.4% of unfavorable treatment outcomes. In the overall sample, treatment follow up actions were below what was recommended for 47% of participants. There was no association between the epidemiological profile of the cases and the outcome of the pharmacological treatment. The smaller number of actions offered was associated with cases of tuberculosis retreatment, with chest X-rays for a positive diagnosis, the use of the special pharmacological treatment regimen, and comorbidities, including HIV, mental illness and the use of self-reported illicit drugs. This study presents unprecedented results regarding the monitoring of people with tuberculosis during the pandemic and identified a high occurrence of unfavorable results from pharmacological treatment and unsatisfactory offer of monitoring actions. The results indicate the influence of clinical characteristics on the receipt of follow-up actions during treatment for tuberculosis in a reference service in the Covid-19 pandemic scenario. Public health measures aimed at maintaining treatment follow-up actions can minimize the effects of the pandemic on tuberculosis indicators and contribute to disease control, promoting the therapeutic success of affected people and interrupting the transmission chain of the bacillus.