BACKGROUND. Tuberculosis (TB) is a major contributor to mortality among patients affected by HIV. TB diagnosis can be challenging, especially in those who are severely ill and unable to produce sputum. Urine lipoarabinomannan (LAM) is a rapid point-of-care diagnostic tool that is used on urine. The dilemma arises if a urine LAM test yields a negative result when the clinical presentation is strongly suggestive of TB. OBJECTIVE. To investigate how a urine LAM test result changes the physician's decision to start TB treatment in people living with HIV in Kalafong Provincial Tertiary Hospital (KPTH). METHOD. A cross-sectional study was done at KPTH in the internal medicine wards, family medicine and HIV outpatient departments. Patients who were HIV positive with a strong TB diagnosis suspicion, had a CD4 count <200 cells/mm³, were aged >13 years and had a urine LAM done to investigate TB were included. Outcomes investigated were: presenting symptoms, clinical signs, radiological and haematological investigations, including CD4 count and HIV viral load, urine LAM results and whether TB treatment was initiated or not. At KPTH, a register of all patients who have been given a urine LAM test is held at the TB notification centre, which was where the information regarding urine LAM results was retrieved from, as well as whether treatment was initiated or not. The patients' clinical hospital records and National Health Laboratory Service lab results were retrieved for necessary information. RESULTS. There were 430 patient records and urine LAM results retrieved: 307 (71.4%) had negative results and 123 (28.6%) had positive results. Of the 307 (71.4%) with a negative result, 120 (39.1%) were initiated on treatment, and only 3 of those who had positive results (1.6%) did not receive treatment. The urine LAM test results appeared to influence clinicians' decisions to treat when the result was positive. If the urine LAM was negative, clinicians still initiated treatment based on adequate clinical suspicion and other investigations. There was significant incongruency between patients with a negative urine LAM test who received TB treatment (p<0.001). CONCLUSION. The use of the urine LAM did not change the physician's decision to start TB treatment where the was a high suspicion of TB based on clinical presentation and other investigations. Physicians depended more on their clinical intuition where the urine LAM was negative.

BACKGROUND: Treatment success rate is a critical indicator for monitoring the progress of tuberculosis (TB) treatment programmes at both the patient and population levels. It informs decisions about resource allocation and the effectiveness of TB control strategies. This study aimed to determine the level of TB cure rates and the factors associated with treatment success among TB patients receiving TB care in the Collins Chabane municipality, Limpopo province, South Africa. METHODS: Medical records from April 2020 to March 2021 of 289 patients attending primary health care facilities, initiated on anti-TB treatment were reviewed. Descriptive statistics were used to analyse data and modified Poisson regression was used to determine factors associated with treatment success. Statistical software Epi Info was used for analysis. RESULTS: Of the 289 TB cases, 282 (97.6%) were newly initiated on TB treatment. Of these, 37.0% were cured, followed by 29.0% who defaulted treatment, 22.3% who completed the treatment and 11.7% who died during treatment. The likelihood of successful treatment outcomes was significantly associated with marital status, supervised treatment and distance travelled to a health facility. A higher likelihood of success was observed among patients who were single and 27.0% of those had supervised treatments CONCLUSION: Tuberculosis patients continue to die in the course of treatment. Supervised treatment is a predictor of successful treatment outcomes. CONTRIBUTIONS: This study highlight the need for heightened advocacy for supervised TB treatment and increased effort to combat the death of patients while on TB treatment.

Resumo Analisamos a saúde na Amazônia Legal por meio de indicadores de morbimortalidade e comparação intra e interestadual da região e Brasil. Foram utilizados dados secundários de sistemas oficiais de saúde para examinar a situação de saúde, tendências e clusters no período de 2010 a 2021. As doenças do aparelho circulatório foram a principal causa de morte, representando 23% dos óbitos. Causas externas e doenças respiratórias contribuíram com 16% e 9% dos óbitos; 52,6% dos óbitos infantis ocorreram no período neonatal precoce e a taxa de mortalidade infantil manteve-se acima da média nacional. A razão de mortalidade materna também foi elevada e acima da média nacional entre 2010 e 2021. A taxa de incidência de dengue permaneceu abaixo da média nacional com tendência de queda de -59,50%. No entanto, as taxas de doença de chagas, AIDS, hanseníase, leishmaniose tegumentar americana e tuberculose permaneceram acima da média do país. Concluiu-se que a população da Amazônia brasileira enfrenta desafios em relação à saúde, indicando uma situação preocupante. Os achados auxiliam na identificação de prioridades territoriais para a implementação de ações que visem reduzir a morbimortalidade na região.

Abstract We carried out the health situation analysis in the Legal Amazon through morbidity and mortality indicators and the comparison between intra and inter-state federation of the region and Brazil. Analysis of the health situation, trends, and identification of clusters in the Brazilian Amazon, for the period from 2010 to 2021, using secondary data available in official health information systems. Circulatory diseases were the main cause of death, representing 23% of deaths. External causes and respiratory diseases contributed 16% and 9% of deaths, respectively; 52.6% of infant deaths occurred in the early neonatal period, and the infant mortality rate remained above the national average. The ratio of maternal mortality was also high and above the national average between 2010 and 2021. The dengue incidence rate remained below the national average with a drop trend of -59.50%. However, rates of Chagas disease, AIDS, Hansen’s disease, American cutaneous leishmaniasis and tuberculosis remained above average rates in the country. It was concluded that the population of the Brazilian Amazon faces health challenges. The findings facilitate the identification of territorial priorities for the implementation of actions that impact morbidity and mortality reduction in the region.

Resumen Analizamos la salud en la Amazonía Legal utilizando indicadores de morbimortalidad y comparaciones intra e interestatales de la región y Brasil. Se utilizaron datos secundarios de los sistemas de salud oficiales para examinar la situación, las tendencias y los grupos de salud en el período de 2010 a 2021. Las enfermedades del sistema circulatorio fueron la principal causa de muerte, representando el 23% de las muertes. Las causas externas y las enfermedades respiratorias contribuyeron al 16% y al 9% de las muertes; el 52,6% de las muertes infantiles ocurrieron en el período neonatal temprano y la tasa de mortalidad infantil se mantuvo por encima del promedio nacional. La tasa de mortalidad materna también fue alta y superior al promedio nacional entre 2010 y 2021. La tasa de incidencia del dengue se mantuvo por debajo del promedio nacional con una tendencia a la baja del -59,50%. Sin embargo, las tasas de enfermedad de Chagas, SIDA, lepra, leishmaniasis cutánea americana y tuberculosis se mantuvieron por encima del promedio del país. Se concluyó que la población de la Amazonía brasileña enfrenta desafíos en relación a la salud, indicando una situación preocupante. Los hallazgos ayudan a identificar prioridades territoriales para implementar acciones destinadas a reducir la morbilidad y la mortalidad en la región.

Abstract Rifampicin (RFP) is used for the treatment of chronic bone tuberculosis owing to its powerful and wide spectrum antibacterial activities. However, effective concentrations of RFP required to treat bone tuberculosis are maintained for a short time in vivo, and adverse reactions and bone defects may occur after surgery. Therefore, the construction of a new drug delivery system to overcome these problems is required. In this study, we designed, constructed, and demonstrated the applicability of a calcium phosphate cement scaffold loaded with RFP liposomes for the treatment of bone tuberculosis. RFP liposomes were prepared using a film dispersion method. The preparation method was optimized using the encapsulation rate as an indicator and the morphology, mean particle size, zeta potential, encapsulation rate, and drug loading of RFP liposomes were characterized. Calcium phosphate cement scaffolds were constructed using 3D printing technology and used as RFP liposome carriers for sustained-release drug delivery. Finally, some of the properties were verified in vivo through experiments in rabbits. The results indicated that composite scaffolds can provide sustained drug release and are a promising treatment option for bone tuberculosis.

ABSTRACT BACKGROUND: The diagnosis and treatment of latent tuberculosis infection (LTBI) are crucial for tuberculosis (TB) control. Household contacts (HHC) of patients with pulmonary TB are at a high risk of LTBI due to their close proximity to source cases. OBJECTIVE: To describe the diagnosis and treatment of LTBI among HHC. DESIGN AND SETTING: This cross-sectional follow-up study was conducted in the municipality of Paulo Afonso, northeastern Brazil, between 2013 and 2022. METHODS: We retrieved secondary data from the medical records of HHC who were followed up at a specialized referral center for TB. LTBI prevalence estimates were calculated and are presented with 95% confidence intervals (CIs). RESULTS: In total, 622 HHC were screened for LTBI, with 620 evaluated using the tuberculin skin test (TST). Of these, 40 (6.5%) did not return for TST reading. The overall prevalence of LTBI was 53.1% (95% CI: 49–57.1%), with a high prevalence among females and individuals aged 25–34 years. The overall LTBI treatment initiation rate was 26.1% (95%CI: 21.5–31.3%), and 64.2% (95%CI: 53.3–73.8%) of HHC who initiated treatment completed their course. CONCLUSION: This study revealed a high prevalence of LTBI among HHC, particularly among women and individuals aged 25–34 years, underscoring the ongoing TB transmission within the community. Only 26.1% of the diagnosed HHC initiated treatment, with approximately 64% completing their course. This highlights the challenges in managing LTBI and emphasizes the need for targeted screening and interventions for high-risk groups. BACKGROUND (LTBI (TB control (HHC cases OBJECTIVE SETTING crosssectional cross sectional followup follow Afonso Brazil 201 2022 METHODS 95 CIs. CIs . (CIs) RESULTS total 62 TST. (TST) these 4 6.5% 65 6 5 (6.5% reading 531 53 1 53.1 (95 CI 49–57.1%, 49571 49–57.1% , 49 57 49–57.1%) 2534 25 34 25–3 years 261 26 26.1 95%CI 95CI (95%CI 21.5–31.3%, 215313 21.5–31.3% 21 31 3 21.5–31.3%) 642 64 2 64.2 53.3–73.8% 533738 73 8 course CONCLUSION community highrisk groups 20 202 9 (CIs (TST 6.5 (6.5 53. (9 4957 49–57.1 253 25– 26. 21531 21.5–31.3 64. 53.3–73.8 53373 7 6. (6. ( 495 49–57. 2153 21.5–31. 53.3–73. 5337 (6 49–57 215 21.5–31 53.3–73 533 49–5 21.5–3 53.3–7 49– 21.5– 53.3– 21.5 53.3 21.

BACKGROUND: Community health workers (CHWs) work with community members who experience various health problems. They assist community members to lead a healthy life and achieve an acceptable health status. To achieve this, there is a need for CHWs to apply Ubuntu philosophy when providing care related tuberculosis (TB), Human Immunodeficiency Virus (HIV), and acquired immunodeficiency syndrome (AIDS). OBJECTIVES: The aim of this study was to assess CHW's knowledge of Ubuntu-informed Care in tuberculosis, HIV, and AIDS Services in Gauteng province, South Africa. METHOD: A total of 380 CHWs were recruited from a district in Gauteng province to participate in a training on the management of TB, HIV and AIDS. A questionnaire with 40 multiple choice questions was administered to the CHWs before the training. SPSS version 28 was used to analyse the data. RESULTS: The scores ranged from 9 to 33 out of 40 (M = 21.6, s.d. = 4.2). Out of the 380 participants, 274 (72.1%) passed the pretest while 106 participants (27.9%) failed. The highest mean scores were achieved by female participants (M = 21.6, s.d. = 4.3), participants aged 21-30 years (M = 21.8, s.d. = 4.1) and participants with additional course qualification after Grade 12 (M = 23.5, s.d. = 3.4 CONCLUSION: The findings highlight the need for targeted training interventions to improve the knowledge of CHWs on TB, HIV and AIDS. CONTRIBUTION: This study adds to the literature on the need for inclusion of Ubuntu when caring for people living with HIV and TB.

Objetivou-se sintetizar as evidências de estudos qualitativos sobre as experiências de tratamento para tuberculose das pessoas em situação de rua. Conduziu-se uma revisão sistemática com metassíntese cuja busca de estudos ocorreu em dez bases de dados, de janeiro a junho de 2023. Identificaram-se 3.801 publicações, das quais cinco foram incluídas. Esta metassíntese refletiu as barreiras enfrentadas pela população em situação de rua durante o tratamento da tuberculose, originadas por uso de drogas, preconceito, ausência de rede de apoio, dificuldades para deslocamento aos estabelecimentos de saúde, não priorização do tratamento e baixa resolutividade dos serviços, que, muitas vezes, negligenciam as singularidades das pessoas atendidas. Em contrapartida, o cuidado integral e humanizado; descentralizado à atenção primária à saúde; e balizado por práticas articuladas e vinculadoras apoiadas pela família promoveu adesão ao tratamento e vinculação às equipes.

El objetivo fue sintetizar las evidencias de estudios cualitativos sobre las experiencias de tratamiento para la tuberculosis de las personas sin hogar. Se realizó una revisión sistemática con metasíntesis, cuya búsqueda de estudios tuvo lugar en diez bases de datos, de enero a junio de 2023. Se identificaron 3.801 publicaciones, de las cuales se incluyeron cinco. Esta metasíntesis reflejó las barreras enfrentadas por la población sin hogar durante el tratamiento de la tuberculosis, originadas por el uso de drogas, los prejuicios, la ausencia de una red de apoyo, las dificultades para el desplazamiento a los establecimientos de salud y la no priorización del tratamiento, además de la baja capacidad de resolución de los servicios que, muchas veces, son negligentes con sus singularidades. En contrapartida, el cuidado integral y humanizado descentralizado de la atención primaria de la salud, delimitado por prácticas articuladas y vinculadoras apoyadas por la familia, promovió adhesión al tratamiento y vínculo con los equipos.

We aimed to synthesize the evidence from qualitative studies on the experiences of tuberculosis treatment among people living on the streets. We conducted a systematic review with meta-synthesis, searching for studies in ten databases from January to June 2023. We identified 3,801 publications, five of which were included in the study. This meta-synthesis reflects the barriers faced by the people living on the streets during tuberculosis treatment. These barriers originate from drug use, prejudice, lack of a support network, difficulties in accessing health establishments, and the low prioritization of treatment. Furthermore, there are issues with service resolution and accessibility, which often neglect the unique needs of these individuals. In contrast, comprehensive and humanized care, decentralized to primary health care, characterized by coordinated practices and family support, promotes access to treatment and strengthens connections with healthcare teams.

Este estudo objetivou analisar o custo-efetividade de três testes cutâneos baseados em antígenos de tuberculose (TB) (Diaskintest, C-TST, Cy-TB) e QFT-Plus para diagnóstico de infecção por TB comparando-os ao padrão de atendimento atual, PPD Rt-23 teste tuberculínico (TT), entre profissionais de saúde no Brasil. Trata-se de um modelo de Markov de transição de estado, simulando uma coorte de profissionais de saúde (cinco ciclos anuais) para testagem e tratamento de infecção por TB com doses semanais de rifapentina e isoniazida por três meses (3HP) sob a perspectiva do sistema público de saúde brasileiro. Os efeitos (TB evitada) e os custos de triagem e tratamento da infecção foram descontados em 5%. O custo-efetividade incremental por TB evitada foi calculado. Foram realizadas análises de sensibilidade unidirecionais e probabilísticas. O Brasil, um país de renda média-alta com alta carga de TB, possui um dos maiores sistemas públicos universais de saúde e oferece diagnóstico e tratamento gratuitos para TB. O TT é o atendimento padrão, o QFT-Plus está disponível para populações de risco muito elevado. Os três novos testes cutâneos estão em validação para eventual incorporação. Uma coorte hipotética de 10 mil profissionais de saúde, trabalhando em qualquer nível de atendimento, e resultados negativos de TT no ano anterior de ambos os sexos com um resultado de TT negativo na linha de base. Diaskintest, C-TST, Cy-TB e QFT-Plus têm maior especificidade. Os custos com o QFT-Plus foram maiores devido: equipamento, mão de obra e custo da testagem. O Diaskintest foi a estratégia de maior economia, seguido pelo Cy-TB para tratamento preventivo da TB com 3HP. No cenário brasileiro, Diaskintest e Cy-TB são os testes mais custo-efetivos para testagem sequencial de profissionais da saúde.

Este estudio tuvo como objetivo analizar el costo-efectividad de tres pruebas cutáneas basadas en antígenos de tuberculosis (TB) (Diaskintest, C-TST, Cy-TB) y QFT-Plus para diagnosticar la infección por TB comparándolas con el estándar de atención actual, PPD Rt-23 prueba de la tuberculina (TT), entre profesionales de la salud en Brasil. Se trata de un modelo de Markov de transición de estado, que simula una cohorte de profesionales de la salud (cinco ciclos anuales) para pruebas y tratamiento de la infección por TB con dosis semanales de rifapentina e isoniazida durante tres meses (3HP) desde la perspectiva del sistema de salud pública brasileño. Los efectos (TB evitada) y los costos de detección y tratamiento de la infección se descontaron en un 5%. Se calculó el costo-efectividad incremental por TB evitada. Se realizaron análisis de sensibilidad unidireccionales y probabilísticos. Brasil, un país de ingresos medianos altos con una alta carga de TB, tiene uno de los mayores sistemas de salud pública universal y ofrece diagnóstico y tratamiento gratuitos para la TB. El TT es la atención estándar, QFT-Plus está disponible para poblaciones de muy alto riesgo. Las tres nuevas pruebas cutáneas se encuentran en proceso de validación para su eventual incorporación. Una cohorte hipotética de 10.000 profesionales de la salud, trabajando en cualquier nivel de atención, y resultados de TT negativos en el año anterior de ambos sexos con resultado de TT negativo en la línea de base. Diaskintest, C-TST, Cy-TB y QFT-Plus tienen mayor especificidad. Los costos con QFT-Plus fueron mayores debido a: equipo, mano de obra y costo de las pruebas. Diaskintest fue la estrategia más rentable, seguida de Cy-TB para tratamiento preventivo de la TB con 3HP. En el escenario brasileño, Diaskintest y Cy-TB son las pruebas más rentables para realizar pruebas secuenciales a los profesionales de la salud.

This study aimed to analyze the cost-effectiveness of three tuberculosis (TB) antigen-based skin tests (TBST) (Diaskintest, C-TST, and Cy-TB) and QFT-Plus for TB infection diagnosis compared to the current standard of care, PPD Rt-23 tuberculin skin test (TST), among healthcare workers in Brazil. A state-transition Markov model was employed, simulating a cohort of healthcare workers (five annual cycles) for testing and treating TB infection with three months of weekly doses of rifapentine and isoniazid (3HP) under the Brazilian public health system perspective. Effects (TB disease averted) and costs for screening and treating TB infection were discounted at 5%. Incremental cost-effectiveness per TB averted was estimated. One-way and probabilistic sensitivity analysis were performed. Brazil, an upper-middle-income country with a high burden of TB, shows one of the largest universal public health systems and provides free-of-charge diagnosis and treatment for TB and TB infection. TST is the standard of care, whereas QFT-Plus is available for very high-risk populations. The three new TBST are under validation for eventual incorporation. Patients or participants: a hypothetical cohort of 10,000 healthcare workers, working at any level of healthcare service, and negative TST results in the previous year of both sexes with a baseline negative TST result. Diaskintest, C-TST, Cy-TB, and QFT-Plus were found to show a higher specificity. Costs with QFT-Plus were higher due to equipment, human labor, and test price. Diaskintest was the most cost-saving strategy, followed by Cy-TB for TB preventive treatment with 3HP. In the Brazilian scenario, Diaskintest and Cy-TB are the most cost-effective tests for sequential testing of healthcare workers.

Resumo Analisamos a saúde na Amazônia Legal por meio de indicadores de morbimortalidade e comparação intra e interestadual da região e Brasil. Foram utilizados dados secundários de sistemas oficiais de saúde para examinar a situação de saúde, tendências e clusters no período de 2010 a 2021. As doenças do aparelho circulatório foram a principal causa de morte, representando 23% dos óbitos. Causas externas e doenças respiratórias contribuíram com 16% e 9% dos óbitos; 52,6% dos óbitos infantis ocorreram no período neonatal precoce e a taxa de mortalidade infantil manteve-se acima da média nacional. A razão de mortalidade materna também foi elevada e acima da média nacional entre 2010 e 2021. A taxa de incidência de dengue permaneceu abaixo da média nacional com tendência de queda de -59,50%. No entanto, as taxas de doença de chagas, AIDS, hanseníase, leishmaniose tegumentar americana e tuberculose permaneceram acima da média do país. Concluiu-se que a população da Amazônia brasileira enfrenta desafios em relação à saúde, indicando uma situação preocupante. Os achados auxiliam na identificação de prioridades territoriais para a implementação de ações que visem reduzir a morbimortalidade na região.

Resumen Analizamos la salud en la Amazonía Legal utilizando indicadores de morbimortalidad y comparaciones intra e interestatales de la región y Brasil. Se utilizaron datos secundarios de los sistemas de salud oficiales para examinar la situación, las tendencias y los grupos de salud en el período de 2010 a 2021. Las enfermedades del sistema circulatorio fueron la principal causa de muerte, representando el 23% de las muertes. Las causas externas y las enfermedades respiratorias contribuyeron al 16% y al 9% de las muertes; el 52,6% de las muertes infantiles ocurrieron en el período neonatal temprano y la tasa de mortalidad infantil se mantuvo por encima del promedio nacional. La tasa de mortalidad materna también fue alta y superior al promedio nacional entre 2010 y 2021. La tasa de incidencia del dengue se mantuvo por debajo del promedio nacional con una tendencia a la baja del -59,50%. Sin embargo, las tasas de enfermedad de Chagas, SIDA, lepra, leishmaniasis cutánea americana y tuberculosis se mantuvieron por encima del promedio del país. Se concluyó que la población de la Amazonía brasileña enfrenta desafíos en relación a la salud, indicando una situación preocupante. Los hallazgos ayudan a identificar prioridades territoriales para implementar acciones destinadas a reducir la morbilidad y la mortalidad en la región.

Abstract We carried out the health situation analysis in the Legal Amazon through morbidity and mortality indicators and the comparison between intra and inter-state federation of the region and Brazil. Analysis of the health situation, trends, and identification of clusters in the Brazilian Amazon, for the period from 2010 to 2021, using secondary data available in official health information systems. Circulatory diseases were the main cause of death, representing 23% of deaths. External causes and respiratory diseases contributed 16% and 9% of deaths, respectively; 52.6% of infant deaths occurred in the early neonatal period, and the infant mortality rate remained above the national average. The ratio of maternal mortality was also high and above the national average between 2010 and 2021. The dengue incidence rate remained below the national average with a drop trend of -59.50%. However, rates of Chagas disease, AIDS, Hansen’s disease, American cutaneous leishmaniasis and tuberculosis remained above average rates in the country. It was concluded that the population of the Brazilian Amazon faces health challenges. The findings facilitate the identification of territorial priorities for the implementation of actions that impact morbidity and mortality reduction in the region.

RESUMO Objetivo: A última edição do Levantamento de Cenas de Uso de Capitais (LECUCA) investigou indicadores de vulnerabilidade social, de saúde e uso de serviços de saúde e assistência entre frequentadores das cenas abertas de uso (CAU) de crack em São Paulo, Fortaleza e Brasília entre 2021/2022. Métodos: Desde 2016, o LECUCA utiliza a amostragem por Tempo-Localização (TLS) para selecionar amostras probabilísticas representativas da população de frequentadores da CAU. Resultados: Foram entrevistados 579 participantes em São Paulo, Fortaleza e Brasília, com índice de resposta de 75%. Os frequentadores das CAUs não se diferenciam nas prevalências de indicadores sociodemográficos e tempo na cena. As prevalências de frequentadores que nunca estiveram em situação de rua antes de viver na CAU e provenientes de casa foram igualmente altas nas três capitais. Fortaleza se destaca com menores índices de situação de rua e de acesso a equipamentos de saúde especializados, enquanto Brasília apresenta índices elevados de busca por emergência devido ao consumo de drogas e maior acesso a todas as modalidades de serviço de saúde e assistência. Mais de um terço dos frequentadores das CAUs pratica sexo desprotegido e nenhuma das capitais teve mais da metade dos frequentadores testados para Tuberculose e Infecções Sexualmente Transmissíveis (ISTs). Os índices de problemas na gestação foram altos entre todas as capitais, com os menores índices em São Paulo. Conclusão: O LECUCA oferece subsídios importantes para gestores governamentais e institucionais, com o intuito de catalisar o desenvolvimento de políticas públicas e estratégias de atendimento fundamentadas em dados e evidências.

ABSTRACT Objective: The latest edition of the Open Drug Scenes Survey in Brazilian Cities (LECUCA) investigated social vulnerability, health, and the use of the Psychosocial Care Network by attendees of open drug scenes (ODSs) involving crack cocaine in São Paulo, Fortaleza, and Brasília between 2021/2022. Methods: Since 2016, LECUCA has used Time-Location Sampling (TLS) to select probabilistic samples representative of the population of ODS attendees. Results: We interviewed 579 participants in São Paulo, Fortaleza, and Brasília, obtaining a response rate of 75%. We found no difference in ODS attendees regarding the prevalence of sociodemographic indicators and time living in the ODS. The prevalence values of attendees who had never been homeless before living in the ODS and those living in their homes were equally high in the three capitals. Fortaleza stood out for having lower rates of homelessness and limited access to specialized health services, whereas Brasília had high rates of searching for emergency services due to drug use and greater access to all modalities of health and assistance services. Unprotected sex was prevalent over one third of ODSs attendees, and none of the capitals had more than half of the attendees testing for tuberculosis and sexually transmitted infections. Rates of pregnancy complications were high in all three capitals, with São Paulo accounting for the lowest rates. Conclusion: LECUCA provides significant subsidies to governmental and institutional managers, aiming at catalyzing the formulation of public policies and care strategies based on data and evidence.

Apesar dos esforços para a redução da incidência, o controle da tuberculose (TB) ainda representa um desafio para a cidade do Rio de Janeiro, Brasil. O objetivo deste artigo é analisar a tendência temporal e o efeito das ações de vigilância de TB e do acesso aos serviços de saúde na detecção de casos de TB na cidade do Rio de Janeiro (2014-2022). Realizou-se um estudo ecológico que avaliou todos os casos de TB notificados mensalmente em residentes da cidade do Rio de Janeiro. Foi elaborado um modelo de regressão segmentada de joinpoint para identificar pontos de mudança na tendência de notificações e calcular a variação percentual mensal. Modelos aditivos generalizados foram utilizados para avaliar o efeito da implantação do teste rápido molecular, das ações de vigilância de TB e da cobertura de atenção primária na detecção de casos de TB. De janeiro de 2014 a dezembro de 2022, houve uma mediana de 677 casos de TB por mês, com uma variação mensal ascendente, de 0,49% (IC95%: 0,19; 0,79) de janeiro de 2014 a agosto de 2017 e de 0,72% (IC95%: 0,16; 1,29) de dezembro de 2020 a dezembro de 2022. Nos modelos múltiplos, o número de visitas domiciliares e o percentual da cobertura de atenção primária estiveram associados à notificação dos casos de TB. Conclui-se que o acesso aos serviços de atenção primária e o aumento das visitas domiciliares são essenciais para ampliar a detecção de casos de TB na cidade do Rio de Janeiro por meio do teste rápido molecular.

A pesar de los esfuerzos para reducir la incidencia de tuberculosis (TB), su control sigue siendo un desafío para la ciudad de Río de Janeiro, Brasil. Los objetivos de este estudio fueron analizar la tendencia temporal y el efecto de las acciones de vigilancia de la TB y el acceso a los servicios de salud en la detección de casos de TB en la ciudad de Río de Janeiro (2014-2022). Se realizó un estudio ecológico para evaluar todos los casos de TB reportados mensualmente en residentes de la ciudad de Río de Janeiro. Se desarrolló un modelo de regresión joinpoint segmentado para identificar puntos de cambio en la tendencia de informes y calcular el cambio porcentual mensual. Se utilizaron modelos aditivos generalizados para evaluar el efecto de la implementación de la prueba molecular rápida, las acciones de vigilancia de la TB y la cobertura de atención primaria en la detección de casos de TB. De enero del 2014 a diciembre del 2022, hubo una mediana de 677 casos de TB por mes, con una variación mensual al alza del 0,49% (IC95%: 0,19; 0,79) de enero del 2014 a agosto del 2017 y del 0,72% (IC95%: 0,16; 1,29) de diciembre del 2020 a diciembre del 2022. En los modelos múltiples, el número de visitas domiciliarias y el porcentual de la cobertura de atención primaria se asociaron con la notificación de casos de TB. El acceso a los servicios de atención primaria y el aumento de las visitas domiciliarias son esenciales para aumentar la detección de casos de TB en la ciudad de Río de Janeiro mediante la prueba molecular rápida.

Despite efforts to reduce its incidence, tuberculosis (TB) control still challenges the municipality of Rio de Janeiro, Brazil. This study aimed to analyze the temporal trend and effect of TB surveillance and access to health services on the detection of TB cases in Rio de Janeiro (2014-2022). This ecological study evaluated all cases of TB that were reported monthly in residents of Rio de Janeiro. A segmented joinpoint regression model was developed to identify points of change in the trend of notifications and calculate monthly percentage changes. Generalized additive models were used to evaluate the effect of implementing the rapid molecular test, TB surveillance actions, and primary care coverage in the detection of TB cases. The period from January 2014 to December 2022 showed a median of 677 cases of TB per month, with an increasing monthly variation of 0.49% (95%CI: 0.19; 0.79) from January 2014 to August 2017 and of 0.72% (95%CI: 0.16; 1.29) from December 2020 to December 2022. The multiple models associated the number of home visits and percentage of primary care coverage with the notification of TB cases. Access to primary care services and the increase in home visits are essential to expand the detection of TB cases in Rio de Janeiro by the rapid molecular test.

Resumen Introducción: la tuberculosis es una enfermedad infecciosa crónica causada por Mycobacterium tuberculosis, capaz de afectar cualquier órgano o tejido siendo la forma más común la enfermedad pulmonar. Objetivo: identificar los factores que afectan la adherencia al tratamiento antituberculoso en pacientes del Departamento de Boyacá durante los años 2017-2019. Metodología: estudio descriptivo retrospectivo que utilizó como fuentes de información datos registrados en la base del programa departamental de Tuberculosis y SIVIGILA. Se realizó análisis univariado, determinando la distribución de las variables y análisis bivariado en el que se exploró la asociación entre la adherencia al tratamiento de tuberculosis y las variables independientes, se utilizó la prueba de Chi cuadrado. Resultados: se incluyeron 402 pacientes, la adherencia al tratamiento antituberculoso fue 96,5% y la no adherencia de 3,5%. El 66,7% eran de sexo femenino; 55,7% vivián en zona urbana; 66,5% pertenecían al régimen subsidiado; 89,7% mestizos; 91,2% correspondían a otros grupos poblacionales, seguido del 7,5% de población privada de la libertad y 1,3% habitantes de calle. Dentro de las comorbilidades la coinfección con VIH con 4,2% fue la de mayor presencia. Entre las causas de no adherencia al tratamiento fueron desinterés, cambio frecuente de domicilio, contrato finalizado con la EPS y suspensión del tratamiento por toxicidad hepática. El paciente con mayor probabilidad de abandonar el tratamiento pertenece al sexo masculino, al grupo poblacional de migrantes o habitantes de calle y se encuentra afiliado al régimen subsidiado, se encontró una relación estadísticamente significativa entre estas variables y el resultado con la adherencia al tratamiento. Conclusiones: si bien el resultado obtenido en el presente trabajo no es elevado, es importante realizar vigilancia de la adherencia al tratamiento antituberculoso para disminuir el riesgo de complicaciones derivadas de su abandono como mayor mortalidad, desarrollo de resistencia bacteriana y un período de contagiosidad más prolongado.

Abstract Introduction: Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, capable of affecting any organ or tissue, the most common form being lung disease. Objective: Identify the factors that affect adherence to tuberculosis treatment in patients from the Department of Boyacá during the years 2017-2019. Methodology: Retrospective descriptive study that used as information sources data registered in the database of the departmental Tuberculosis program and SIVIGILA. A univariate analysis was carried out, determining the distribution of the variables and a bivariate analysis in which the association between adherence to tuberculosis treatment and the independent variables was explored, using the Chi-square test. Results: 402 patients were included, adherence to anti-tuberculosis treatment was 96.5% and non-adherence 3.5%. 66.7% were female; 55.7% lived in an urban area; 66.5% belonged to the subsidized regime; 89.7% mestizo; 91.2% corresponded to other population groups, followed by 7.5% of the population deprived of liberty and 1.3% homeless. Within the comorbidities, coinfection with HIV 4.2% was the one with the greatest presence. Among the causes of non-adherence to treatment were lack of interest; frequent change of address; Terminated contract with the EPS and suspension of treatment due to liver toxicity. The patient with the highest probability of abandoning treatment belongs to the male sex, to the population group of migrants or street dwellers and is affiliated with the subsidized regime, a statistically significant relationship was found between these variables and the result with adherence to treatment. Conclusions: Although the result obtained in this study is not high, it is important to monitor adherence to tuberculosis treatment to reduce the risk of complications derived from its abandonment, such as increased mortality, development of bacterial resistance, and a longer period of contagiousness.

RESUMEN Introducción: la meningitis tuberculosa es la forma más grave de tuberculosis extrapulmonar, esto se debe a la gran mortalidad y morbilidad en los pacientes, con alta prevalencia en los países en desarrollo, lo que constituye un problema de salud pública. Su diagnóstico es difícil y la mayoría de casos se logran identificar a base de criterios clínicos y características del líquido cefalorraquídeo que la mayoría de veces son inespecíficos. Objetivo: determinar las características clínico-epidemiológicas en pacientes con tuberculosis meníngea de los pacientes internados en área de clínica médica en el Hospital Nacional en el periodo 2015-2023. Metodología: estudio observacional descriptivo de corte transversal de pacientes adultos con tuberculosis meníngea internados en el Centro Médico Nacional en el periodo 2015- 2023. Resultados: se incluyeron 32 pacientes entre 20 y 85 años (edad media: 39 años); varones 68,75 %, mujeres 32,25 %. Mayoría provenientes del interior del país. En la mayoría de los casos los pacientes presentaron un aumento de proteínas en el líquido cefalorraquídeo y celularidad predominio de mononucleares, la positividad de GeneXpert de Mycobacterium del líquido cefalorraquídeo fue 62,5 %, en ningún caso se aisló BAAR. Fueron seropositivos para VIH 37,5 % y tenían afección pulmonar concomitante a la meningitis 43,75 %. La mortalidad fue de 31,25 %. Conclusión: la meningitis tuberculosa en nuestra investigación afectó mayormente a hombres de mediana edad provenientes del interior, cuya clínica inicial es la fiebre en mayor porcentaje seguido de cefalea presentando una alta mortalidad.

ABSTRACT Introduction: tuberculous meningitis is the most serious form of extrapulmonary tuberculosis, this is due to the high mortality and morbidity in patients, its diagnosis is difficult and the majority of cases can be identified based on clinical criteria and characteristics of the cerebrospinal fluid that the majority Sometimes they are nonspecific. Objective: determine the clinical-epidemiological characteristics in patients with meningeal tuberculosis of patients admitted to the medical clinic area at the National Hospital in the period 2015-2023. Methodology: retrospective descriptive observational cross-sectional study of adult patients with meningeal tuberculosis admitted to the National Hospital in the period 2015-2023. Results: 32 patients between 20 and 80 years old (mean age: 39 years) were included; men 68.75 %, women 32.25 %. Mostly coming from the interior of the country. In most cases, patients presented an increase in proteins in the cerebrospinal fluid and predominantly mononuclear cellularity. The genxpert positivity of Mycobacterium from the cerebrospinal fluid was 62.5 %; in no case was AFB isolated. 37.5 % were seropositive for HIV and 43.75 % had pulmonary disease concomitant to meningitis. Mortality was 31.25 %. Conclusion: tuberculous meningitis in our research mainly affected middle-aged men from the interior, whose initial symptoms are fever in a higher percentage followed by headache, presenting a high mortality.

RESUMEN La paracoccidioidomicosis es una micosis profunda sistémica, endémica en algunos países de Latinoamérica, de presentación clínica es de evolución aguda/subaguda, en nuestro país es el principal diagnostico diferencial de la tuberculosis pulmonar. Se describe el caso clínico de un hombre de 48 años, procedente de zona rural, inmunocompetente, que se presentó clínicamente por dificultad respiratoria, pérdida de peso de forma progresiva y lesiones en mucosas oral; como hallazgos radiológicos presentó infiltrados reticulares bilaterales. Desde el punto de vista micológico se evidenció la presencia del microorganismo en diversas muestras biológicas: biopsias de lesiones orofaríngeas y estudio micológico del esputo. Se realizó tratamiento dirigido con antimicótico intravenoso presentando buena respuesta al mismo con mejoría clínica.

ABSTRACT Paracoccidioidomycosis is a deep systemic mycosis, endemic in some Latin American countries, with an acute/subacute clinical presentation. In our country, it is the main differential diagnosis of pulmonary tuberculosis. We describe the clinical case of a 48-year-old man from a rural area, immunocompetent, who presented clinically with respiratory distress, progressive weight loss and lesions in the oral mucosa; as radiological findings, he presented bilateral reticular infiltrates. From a mycological point of view, the presence of the microorganism was evidenced in various biological samples: biopsies of oropharyngeal lesions and mycological study of sputum. Targeted treatment with intravenous antifungals was performed, presenting a good response to it with clinical improvement.