Introduction: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, was declared a global public health emergency in 2020, profoundly impacting countries around the world. International border regions, such as the tri-border region between Brazil, Paraguay, and Argentina, faced unique challenges, such as high population mobility and the lack of regional integration in controlling the pandemic. Thus, this study aimed to identify and characterize the epidemic waves of COVID-19 in the three health regions of this tri-border region between 2020 and 2023. Methods: Using secondary epidemiological data, confirmed cases of COVID-19 were analyzed in 9 municipalities in Brazil, 22 in Paraguay, and 13 in Argentina.  Were used to smooth the epidemic curves and identify the waves, their peaks, and valleys based on the EpidemicKabu library, and the cross-correlation statistic function of the epidemic waves in the historical series of the countries. Results: The study revealed five epidemic waves in total, five in Brazil, five in Paraguay and two in Argentina. The relation between the epidemic waves in Brazil and Paraguay was 0.74 and a lag -1, the correlation between Brazil and Argentina was 0.69 and lag max in 0 and the cross-correlation between Paraguay and Argentina resulted in 0.80 and lag max in 0, a strong correlation was observed of the three regions. Conclusions: The results highlight the temporal heterogeneity of epidemic waves across the three countries and the importance of cross-border cooperation for infectious disease control. The study reinforces the need for integrated health policies and coordinated epidemiological surveillance in border regions, especially in areas with intense population mobility.

Introducción: La pandemia de COVID-19, causada por el virus SARS-CoV-2, fue declarada una emergencia de salud pública mundial en 2020, afectando profundamente a países de todo el mundo. Las regiones fronterizas internacionales, como la triple frontera entre Brasil, Paraguay y Argentina, enfrentaron desafíos singulares, como la alta movilidad poblacional y la falta de integración regional en el control de la pandemia. Así, este estudio tuvo como objetivo identificar y caracterizar las ondas epidémicas de COVID-19 en las tres regiones sanitarias de esta triple frontera entre 2020 y 2023.Métodos: Utilizando datos epidemiológicos secundarios, se analizaron casos confirmados de COVID-19 en 9 municipios de Brasil, 22 de Paraguay y 13 de Argentina. Se utilizaron para suavizar las curvas epidémicas e identificar las ondas, sus picos y valles con base en la biblioteca EpidemicKabu y la función de correlación cruzada estadística de las ondas epidémicas en las series históricas de los países.Resultados: El estudio reveló cinco olas epidémicas en total, cinco en Brasil, cinco en Paraguay y dos en Argentina. La relación entre las ondas epidémicas en Brasil y Paraguay fue de 0,74 y un rezago de -1, la correlación entre Brasil y Argentina fue de 0,69 y un rezago máximo de 0 y la correlación cruzada entre Paraguay y Argentina resultó en 0,80 y un rezago máximo de 0, Se observó una fuerte correlación entre las tres regiones.Conclusiones: Los resultados resaltan la heterogeneidad temporal de las ondas epidémicas en los tres países y la importancia de la cooperación transfronteriza para el control de las enfermedades infecciosas. El estudio refuerza la necesidad de políticas de salud integradas y vigilancia epidemiológica coordinada en las regiones fronterizas, especialmente en zonas con intensa movilidad poblacional.

Introdução: A pandemia de COVID-19, causada pelo vírus SARS-CoV-2, foi declarada uma emergência global de saúde pública em 2020, impactando profundamente países ao redor do mundo. Regiões de fronteiras internacionais, como a tríplice fronteira entre Brasil, Paraguai e Argentina, enfrentaram desafios únicos, como alta mobilidade populacional e a falta de integração regional no controle da pandemia. Assim, este estudo teve como objetivo identificar e caracterizar as ondas epidêmicas de COVID-19 nas três regiões de saúde desta tríplice fronteira entre 2020 e 2023. Métodos: Utilizando dados epidemiológicos secundários, foram analisados ​​casos confirmados de COVID-19 em 9 municipios no Brasil, 22 no Paraguai e 13 na Argentina. Foram utilizados para suavizar as curvas epidêmicas e identificar as ondas, seus picos e vales com base na biblioteca EpidemicKabu e na função estatística de correlação cruzada das ondas epidêmicas nas séries históricas dos países. Resultados: O estudo revelou cinco ondas epidêmicas no total, cinco no Brasil, cinco no Paraguai e duas na Argentina. A relação entre as ondas epidêmicas no Brasil e Paraguai foi de 0,74 e um lag -1, a correlação entre Brasil e Argentina foi de 0,69 e lag max em 0 e a correlação cruzada entre Paraguai e Argentina resultou em 0,80 e lag max em 0, foi observada uma forte correlação das três regiões. Conclusões: Os resultados destacam a heterogeneidade temporal das ondas epidêmicas nos três países e a importância da cooperação transfronteiriça para o controle de doenças infecciosas. O estudo reforça a necessidade de políticas de saúde integradas e vigilância epidemiológica coordenada em regiões de fronteira, especialmente em áreas com intensa mobilidade populacional.

Objetivo: Esse estudo teve por objetivo investigar um surto de covid-19 entre PS no serviço de nefrologia de um hospital universitário no Rio de Janeiro em março de 2020 e identificar fatores de risco para infecção pelo SARS-CoV-2. Métodos: Para caracterizar o surto em relação a tríade pessoa-lugar-tempo foi definida como população fonte uma equipe de 59 PS, que foram recrutados e submetidos a entrevistas digitais para reconhecer a ocorrência de sinais e sintomas, comorbidades, de hospitalização durante o período de 1 a 23 de março de 2020. A análise dos dados consistiu na construção e interpretação da curva epidêmica e na identificação de fatores de risco para a infecção durante o surto. Resultados: Dos 59 profissionais do serviço de nefrologia, 43 (73%) participaram do estudo. Eram predominatemente médicos (58%), do sexo feminino (67%), com idade variando de 24 a 69 anos e média de 40 anos. O surto ocorreu entre 1º de março e 23 de março de 2020 e teve pico em 12 e 13 de março. Trinta e dois participantes foram classificados com casos prováveis ​​ou confirmados de covid-19. Entre os casos predominavam mulheres (71%), com idade de 37 anos, predominantemente médicos (45%). Apenas um participante foi hospitalizado. Fatores de risco para covid-19 foram ser médico, trabalhar em outro hospital e ser mulher. Conclusão: Concluímos que houve um surto de covid-19 entre profissionais de saúde do serviço de nefrologia do HUPE em março de 2020. Foram sugeridas medidas de proteção a todos profissionais e exames para infeção para SARS-CoV-2 nos sintomáticos.

Objetivo: Este estudio tuvo como objetivo investigar un brote de covid-19 entre el personal sanitario del servicio de nefrología de un hospital universitario de Río de Janeiro en marzo de 2020 e identificar factores de riesgo para la infección por SARS-CoV-2. Métodos: Para caracterizar el brote en relación con la tríada persona-lugar-tiempo, se definió como población fuente un equipo de 59 PS, quienes fueron reclutados y sometidos a entrevistas digitales para reconocer la aparición de signos y síntomas, comorbilidades y hospitalización. durante el período del 1 al 23 de marzo de 2020. El análisis de datos consistió en construir e interpretar la curva epidémica e identificar factores de riesgo de infección durante el brote. Resultados: De los 59 profesionales del servicio de nefrología, participaron del estudio 43 (73%). Eran predominantemente médicos (58%), mujeres (67%), con edades comprendidas entre 24 y 69 años y una media de 40 años. El brote se produjo entre el 1 y el 23 de marzo de 2020 y alcanzó su punto máximo el 12 y 13 de marzo. Treinta y dos participantes fueron clasificados como casos probables o confirmados de covid-19. Entre los casos predominaron las mujeres (71%), con edad de 37 años, predominantemente médicos (45%). Sólo un participante fue hospitalizado. Los factores de riesgo para el Covid-19 fueron ser médico, trabajar en otro hospital y ser mujer. Conclusión: Concluimos que hubo un brote de covid-19 entre los profesionales de la salud del servicio de nefrología del HUPE en marzo de 2020. Se sugirieron medidas de protección para todos los profesionales y pruebas de infección por SARS-CoV-2 en pacientes sintomáticos.

Objective: This study aimed to investigate a COVID-19 outbreak among HCWs in the nephrology department of a university hospital in Rio de Janeiro in March 2020 and to identify risk factors for SARS-CoV-2 infection. Methods: To characterize the outbreak in relation to the person-place-time triad, a team of 59 HCWs was defined as the source population. They were recruited and submitted to digital interviews to recognize the occurrence of signs and symptoms, comorbidities, and hospitalization during the period from March 1 to 23, 2020. Data analysis consisted of constructing and interpreting the epidemic curve and identifying risk factors for infection during the outbreak. Results: Of the 59 professionals in the nephrology department, 43 (73%) participated in the study. They were predominantly physicians (58%), female (67%), with an age ranging from 24 to 69 years, and an average of 40 years. The outbreak occurred between March 1 and March 23, 2020, and peaked on March 12 and 13. Thirty-two participants were classified as having probable or confirmed cases of COVID-19. The majority of cases were women (71%), aged 37 years, and predominantly physicians (45%). Only one participant was hospitalized. Risk factors for COVID-19 were being a physician, working in another hospital, and being a woman. Conclusion: We conclude that there was an outbreak of COVID-19 among healthcare professionals in the nephrology department of HUPE in March 2020. Protective measures were suggested for all professionals and tests for SARS-CoV-2 infection in symptomatic individuals.

ABSTRACT OBJECTIVE To identify risk factors for death from influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. METHODS A case-control of incident cases of influenza A(H1N1) reported in the epidemiological information systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. RESULTS 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas, 9 cases/10 controls; Pará, 22 cases/77 controls, São Paulo, 19 cases/49 controls; Paraná, 10 cases/54 controls; Rio Grande do Sul, 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among the cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from influenza A(H1N1) were identified. CONCLUSION The risk factors identified in this investigation not only allowed subsidizing the elaboration of clinical conducts but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country.

ABSTRACT OBJECTIVE To identify risk factors for death from influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. METHODS A case-control of incident cases of influenza A(H1N1) reported in the epidemiological information systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. RESULTS 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas, 9 cases/10 controls; Pará, 22 cases/77 controls, São Paulo, 19 cases/49 controls; Paraná, 10 cases/54 controls; Rio Grande do Sul, 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among the cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from influenza A(H1N1) were identified. CONCLUSION The risk factors identified in this investigation not only allowed subsidizing the elaboration of clinical conducts but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country. AH1N1, AH1N1 AHN H1N1 , H N A(H1N1 mortality casecontrol case control Paulo Paraná Pará Amazonas conducted included 7 23 controls follows cases10 cases/1 2 cases77 77 cases/7 1 cases49 49 cases/4 cases54 54 cases/5 cases45 45 3 age, (age) preexisting pre existing congestive failure disease mellitus, mellitus mellitus) ICU admission new “new country AH AH1N HN H1N A(H1N cases1 cases/ cases7 cases4 4 cases5 5 (age

Background: In June 2009, the World Health Organization (WHO) raised the global alert level for the A(H1N1)pdm09 influenza pandemic and at that time sustained transmission in Brazil was established. It was urgent to carry out studies that evaluated possible risk factors for death from Influenza A(H1N1) to improve case management strategies to reduce the lethality of the disease. This study aimed to identify risk factors for death from Influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. Methods: A case-control of incident cases of influenza A(H1N1) reported in the Epidemiological Information Systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. Results: 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas – 9 cases/10 controls, Pará – 22 cases/77 controls, São Paulo – 19 cases/49 controls, Paraná – 10 cases/54 controls, Rio Grande do Sul – 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from Influenza A(H1N1) were identified. Conclusion: The risk factors identified in this investigation allowed subsidizing the elaboration of clinical conducts, but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country.

ABSTRACT Background: Rapid molecular methods such as the line probe assay (LPA) and Xpert® MTB/RIF assay (Xpert) have been recommended by the World Health Organization for drug-resistant tuberculosis (DR-TB) diagnosis. We conducted an interventional trial in DR-TB reference centers in Brazil to evaluate the impact of the use of LPA and Xpert. Methods: Patients with DR-TB were eligible if their drug susceptibility testing results were available to the treating physician at the time of consultation. The standard reference MGITTM 960 was compared with Xpert (arm 1) and LPA (arm 2). Effectiveness was considered as the start of the appropriate TB regimen that matched drug susceptibility testing (DST) and the proportions of culture conversion and favorable treatment outcomes after 6 months. Results: A higher rate of empirical treatment was observed with MGIT alone than with the Xpert assay (97.0% vs. 45.0%) and LPA (98.2% vs. 67.5%). Patients started appropriate TB treatment more quickly than those in the MGIT group (median 15.0 vs. 40.5 days; p<0.01) in arm 1. Compared to the MGIT group, culture conversion after 6 months was higher for Xpert in arm 1 (90.9% vs. 79.3%, p=0.39) and LPA in arm 2 (80.0% vs. 83.0%, p=0.81). Conclusions: In the Xpert arm, there was a significant reduction in days to the start of appropriate anti-TB treatment and a trend towards greater culture conversion in the sixth month.

Abstract INTRODUCTION The recent emergence and rapid spread of Zika and Chikungunya fevers in Brazil, occurring simultaneously to a Dengue fever epidemic, together represent major challenges to public health authorities. This study aimed to identify and compare the 2015-2016 spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia. METHODS We used two study designs comprising a cross-sectional-to-point pattern and an ecological analysis of lattice data. Residential addresses involving notified cases were geocoded. We used four spatial diffusion analysis techniques: (i) visual inspection of the sequential kernel and choropleth map, (ii) spatial correlogram analysis, (iii) spatial local autocorrelation (LISA) changes analysis and, (iv) nearest neighbor index (NNI) modeling. RESULTS Kernel and choropleth maps indicated that arboviruses spread to neighboring areas near the first reported cases and occupied these new areas, suggesting a diffusion expansion pattern. A greater case density occurred in central and western areas. In 2015 and 2016, the NNI best-fit model had an S-curve compatible with an expansion pattern for Zika (R2 = 0.94; 0.95), Chikungunya (R2 = 0.99; 0.98) and Dengue (R2 = 0.93; 0.99) epidemics, respectively. Spatial correlograms indicated a decline in spatial lag autocorrelations for the three diseases (expansion pattern). Significant LISA changes suggested different diffusion patterns, although a small number of changes were detected. CONCLUSIONS These findings indicate diffusion expansion, a unique spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia, namely. Knowing how and where arboviruses spread in Salvador-Bahia can help improve subsequent specific epidemic control interventions.

RESUMO: Introdução: Aproximadamente 9 mil novos casos de tuberculose (TB) por ano são registrados na Argentina, representando uma taxa de incidência de 22 casos por 100 mil habitantes. Não há estudos publicados que avaliaram os fatores que influenciam a distribuição desigual da doença na Argentina. O objetivo deste trabalho foi identificar a relação entre a distribuição dos fatores sociais e econômicos e da tuberculose na Argentina entre 2008 e 2012. Método: Foi realizado um estudo ecológico envolvendo 525 departamentos. Na análise procedeu-se uma regressão linear simples, seguida de regressão linear múltipla para cada grupo de determinantes. Um modelo final com os determinantes da incidência de TB foi construído por meio de regressão linear múltipla. Resultados: Os seguintes determinantes explicam 43% da variabilidade da taxa de incidência de TB entre diferentes jurisdições: aglomeração intradomiciliar, proporção de domicílios com rede de esgoto, proporção de pacientes examinados com sintomas respiratórios e proporção de pacientes com tratamento descontinuado. Discussão: Este estudo contribui de maneira importante para uma melhor compreensão dos fatores que influenciam a ocorrência da TB na Argentina, resultado de um processo multidimensional e complexo. Esses fatores fazem parte da determinação social dessa doença. Conclusão: A incidência de TB está associada a diferentes determinantes, de múltiplos níveis. A heterogeneidade na distribuição da tuberculose na Argentina deve-se, entre outros fatores, pela distribuição desigual de determinantes sociais e de acesso às ações de saúde.

ABSTRACT: Background: In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012. Method: An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB’s incidence was constructed from a model of multiple linear regression. Results: The following determinants explain 43% of the variability of TB’s incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment. Discussion: This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease’s social determination. Conclusion: TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.

RESUMO: Introdução: Aproximadamente 9 mil novos casos de tuberculose (TB) por ano são registrados na Argentina, representando uma taxa de incidência de 22 casos por 100 mil habitantes. Não há estudos publicados que avaliaram os fatores que influenciam a distribuição desigual da doença na Argentina. O objetivo deste trabalho foi identificar a relação entre a distribuição dos fatores sociais e econômicos e da tuberculose na Argentina entre 2008 e 2012. Método: Foi realizado um estudo ecológico envolvendo 525 departamentos. Na análise procedeu-se uma regressão linear simples, seguida de regressão linear múltipla para cada grupo de determinantes. Um modelo final com os determinantes da incidência de TB foi construído por meio de regressão linear múltipla. Resultados: Os seguintes determinantes explicam 43% da variabilidade da taxa de incidência de TB entre diferentes jurisdições: aglomeração intradomiciliar, proporção de domicílios com rede de esgoto, proporção de pacientes examinados com sintomas respiratórios e proporção de pacientes com tratamento descontinuado. Discussão: Este estudo contribui de maneira importante para uma melhor compreensão dos fatores que influenciam a ocorrência da TB na Argentina, resultado de um processo multidimensional e complexo. Esses fatores fazem parte da determinação social dessa doença. Conclusão: A incidência de TB está associada a diferentes determinantes, de múltiplos níveis. A heterogeneidade na distribuição da tuberculose na Argentina deve-se, entre outros fatores, pela distribuição desigual de determinantes sociais e de acesso às ações de saúde.

ABSTRACT: Background: In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012. Method: An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB’s incidence was constructed from a model of multiple linear regression. Results: The following determinants explain 43% of the variability of TB’s incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment. Discussion: This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease’s social determination. Conclusion: TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.

BACKGROUND The prevalence of respiratory symptoms and confirmed tuberculosis (TB) among indigenous groups in Paraguay is unknown. METHODS This study assessed the prevalence of respiratory symptoms, confirmed pulmonary TB, and associated socio-economic factors among indigenous Paraguayan populations. Indigenous persons residing in selected communities were included in the study. A total of 24,352 participants were interviewed at home between October and December 2012. Respiratory symptomatic individuals were defined as those with respiratory symptoms of TB. A hierarchical Poisson regression analysis was performed with four levels: individual characteristics, living conditions and environmental characteristics, source of food, and type of nutrition. FINDINGS In this study, 1,383 participants had respiratory symptoms (5.7%), but only 10 had culture-confirmed TB (41/100,000 inhabitants). The small number of cases did not allow evaluation of the risk factors for TB. Age older than 37 years was associated with a two-fold increased risk of symptoms. Female sex; family history of TB; type of housing; home heating; a lack of hunting, fishing, or purchasing food; and a lack of vegetable consumption were also associated with the presence of symptoms. A lack of cereal consumption had a protective effect. Members of the Ayoreo or Manjui ethnic groups had a three-fold increased risk of symptoms. MAIN CONCLUSION Individual characteristics, dietary habits, and belonging to specific ethnic groups were associated with respiratory symptoms.

O objetivo deste trabalho foi identificar os determinantes individuais e de área da não-adesão ao tratamento da tuberculose (TB) em municípios de Buenos Aires, Argentina. Foi realizado um estudo transversal com um modelo hierarquizado. A análise dos determinantes foi realizada em dois níveis por meio de análise de regressão logística em dois níveis, com base em dados primários e secundários. Além disso, a falta de abastecimento de água em casa aumentou o risco de não-adesão. Nesses domicílios, cujo chefe de família não tinha a cobertura de saúde, também o risco de não-adesão foi maior, como em pacientes que usaram mais de um meio de transporte para chegar ao centro de saúde. Em áreas com uma maior proporção de domicílios com uma rede de gás natural e com necessidades básicas insatisfeitas para os meios de vida e uma maior proporção de domicílios sem sanitários foi maior o risco de não-adesão. Conclui-se que os fatores sociais e econômicos influenciam a adesão ao tratamento da TB, tanto individualmente como em termos de área.

This study aimed to identify the individual and environmental determinants of nonadherence to tuberculosis (TB) treatment in selected districts in the Buenos Aires Metropolitan Area, in Argentina. We conducted a cross-sectional study using a hierarchical model. Using primary and secondary data, logistic regression was performed to analyze two types of determinants. The likelihood of nonadherence to treatment was greatest among male patients. The following factors led to a greater likelihood of nonadherence to treatment: patients living in a home without running water; head of household without medical insurance; need to use more than one means of transport to reach the health center; place of residence in an area with a high proportion of households connected to the natural gas network; place of residence in an area where a large proportion of families fall below the minimum threshold of subsistence capacity; place of residence in an area where a high proportion of households do not have flushing toilets and basic sanitation. Our results show that social and economic factors – related to both individual and environmental characteristics – influence adherence to TB treatment.

El objetivo fue identificar los determinantes individuales y de área de la no adherencia al tratamiento de la tuberculosis (TB) en municipios de Buenos Aires, Argentina. Se realizó un estudio transversal con un modelo jerarquizado. El análisis se llevó a cabo mediante regresión logística múltiple en dos niveles, en base a datos primarios y secundarios. Los varones tuvieron mayor riesgo de no adherencia al tratamiento. La falta de provisión de agua en el hogar aumentó el riesgo de no adherencia. En aquellos hogares cuyo jefe de familia no tenía cobertura de salud también el riesgo de no adherencia fue mayor, al igual que en los pacientes que utilizaron más de un medio de transporte para llegar al centro de salud. En las áreas con mayor proporción de hogares con red de gas natural, mayor proporción de hogares con necesidades básicas instisfechas por la capacidad de subsistencia y mayor proporción de hogares que no tenían inodoros fue mayor el riesgo de no adherencia. Se concluye que los factores sociales y económicos tienen influencia sobre la adherencia al tratamiento, tanto a nivel individual, como de área.

O objetivo deste trabalho foi identificar os determinantes individuais e de área da não-adesão ao tratamento da tuberculose (TB) em municípios de Buenos Aires, Argentina. Foi realizado um estudo transversal com um modelo hierarquizado. A análise dos determinantes foi realizada em dois níveis por meio de análise de regressão logística em dois níveis, com base em dados primários e secundários. Além disso, a falta de abastecimento de água em casa aumentou o risco de não-adesão. Nesses domicílios, cujo chefe de família não tinha a cobertura de saúde, também o risco de não-adesão foi maior, como em pacientes que usaram mais de um meio de transporte para chegar ao centro de saúde. Em áreas com uma maior proporção de domicílios com uma rede de gás natural e com necessidades básicas insatisfeitas para os meios de vida e uma maior proporção de domicílios sem sanitários foi maior o risco de não-adesão. Conclui-se que os fatores sociais e econômicos influenciam a adesão ao tratamento da TB, tanto individualmente como em termos de área.

This study aimed to identify the individual and environmental determinants of nonadherence to tuberculosis (TB) treatment in selected districts in the Buenos Aires Metropolitan Area, in Argentina. We conducted a cross-sectional study using a hierarchical model. Using primary and secondary data, logistic regression was performed to analyze two types of determinants. The likelihood of nonadherence to treatment was greatest among male patients. The following factors led to a greater likelihood of nonadherence to treatment: patients living in a home without running water; head of household without medical insurance; need to use more than one means of transport to reach the health center; place of residence in an area with a high proportion of households connected to the natural gas network; place of residence in an area where a large proportion of families fall below the minimum threshold of subsistence capacity; place of residence in an area where a high proportion of households do not have flushing toilets and basic sanitation. Our results show that social and economic factors – related to both individual and environmental characteristics – influence adherence to TB treatment.

El objetivo fue identificar los determinantes individuales y de área de la no adherencia al tratamiento de la tuberculosis (TB) en municipios de Buenos Aires, Argentina. Se realizó un estudio transversal con un modelo jerarquizado. El análisis se llevó a cabo mediante regresión logística múltiple en dos niveles, en base a datos primarios y secundarios. Los varones tuvieron mayor riesgo de no adherencia al tratamiento. La falta de provisión de agua en el hogar aumentó el riesgo de no adherencia. En aquellos hogares cuyo jefe de familia no tenía cobertura de salud también el riesgo de no adherencia fue mayor, al igual que en los pacientes que utilizaron más de un medio de transporte para llegar al centro de salud. En las áreas con mayor proporción de hogares con red de gas natural, mayor proporción de hogares con necesidades básicas instisfechas por la capacidad de subsistencia y mayor proporción de hogares que no tenían inodoros fue mayor el riesgo de no adherencia. Se concluye que los factores sociales y económicos tienen influencia sobre la adherencia al tratamiento, tanto a nivel individual, como de área.

OBJECTIVE Identify spatial distribution patterns of the proportion of nonadherence to tuberculosis treatment and its associated factors.METHODS We conducted an ecological study based on secondary and primary data from municipalities of the metropolitan area of Buenos Aires, Argentina. An exploratory analysis of the characteristics of the area and the distributions of the cases included in the sample (proportion of nonadherence) was also carried out along with a multifactor analysis by linear regression. The variables related to the characteristics of the population, residences and families were analyzed.RESULTS Areas with higher proportion of the population without social security benefits (p = 0.007) and of households with unsatisfied basic needs had a higher risk of nonadherence (p = 0.032). In addition, the proportion of nonadherence was higher in areas with the highest proportion of households with no public transportation within 300 meters (p = 0.070).CONCLUSIONS We found a risk area for the nonadherence to treatment characterized by a population living in poverty, with precarious jobs and difficult access to public transportation.

OBJETIVO Identificar patrones de distribución espacial de la proporción de la no-adherencia al tratamiento de la tuberculosis y sus factores asociados.METODOS Estudio ecológico con datos secundarios y primarios en municipios seleccionados del Área Metropolitana de Buenos Aires. Se realizó un análisis exploratorio de las características del área y de las distribuciones de los casos incluidos en la muestra (proporción de no-adherencia) y un análisis de múltiples factores por regresión lineal. Se analizaron variables referidas a las características de la población, las viviendas y los hogares.RESULTADOS Las áreas con mayor proporción de población que no realizaba aportes jubilatorios (p = 0,007) y con mayor proporción de hogares con necesidades básicas insatisfechas según capacidad de subsistencia presentaron mayor riesgo de no-adherencia (p = 0,032). La proporción de no-adherencia fue más elevada en las áreas con mayor proporción de viviendas sin servicio de transporte público a menos de 300 m (p = 0,070).CONCLUSIONES Existe un área de riesgo para la no-adherencia al tratamiento, caracterizada por tener una población que vive en condiciones de pobreza y precariedad laboral, con dificultades de acceso al servicio de transporte público.

OBJECTIVE Identify spatial distribution patterns of the proportion of nonadherence to tuberculosis treatment and its associated factors.METHODS We conducted an ecological study based on secondary and primary data from municipalities of the metropolitan area of Buenos Aires, Argentina. An exploratory analysis of the characteristics of the area and the distributions of the cases included in the sample (proportion of nonadherence) was also carried out along with a multifactor analysis by linear regression. The variables related to the characteristics of the population, residences and families were analyzed.RESULTS Areas with higher proportion of the population without social security benefits (p = 0.007) and of households with unsatisfied basic needs had a higher risk of nonadherence (p = 0.032). In addition, the proportion of nonadherence was higher in areas with the highest proportion of households with no public transportation within 300 meters (p = 0.070).CONCLUSIONS We found a risk area for the nonadherence to treatment characterized by a population living in poverty, with precarious jobs and difficult access to public transportation.

OBJETIVO Identificar patrones de distribución espacial de la proporción de la no-adherencia al tratamiento de la tuberculosis y sus factores asociados.METODOS Estudio ecológico con datos secundarios y primarios en municipios seleccionados del Área Metropolitana de Buenos Aires. Se realizó un análisis exploratorio de las características del área y de las distribuciones de los casos incluidos en la muestra (proporción de no-adherencia) y un análisis de múltiples factores por regresión lineal. Se analizaron variables referidas a las características de la población, las viviendas y los hogares.RESULTADOS Las áreas con mayor proporción de población que no realizaba aportes jubilatorios (p = 0,007) y con mayor proporción de hogares con necesidades básicas insatisfechas según capacidad de subsistencia presentaron mayor riesgo de no-adherencia (p = 0,032). La proporción de no-adherencia fue más elevada en las áreas con mayor proporción de viviendas sin servicio de transporte público a menos de 300 m (p = 0,070).CONCLUSIONES Existe un área de riesgo para la no-adherencia al tratamiento, caracterizada por tener una población que vive en condiciones de pobreza y precariedad laboral, con dificultades de acceso al servicio de transporte público.

Objetivou-se avaliar a acessibilidade ao diagnóstico da tuberculose nos serviços de saúde em Vitória (ES). Estudo transversal realizado em 2009 com doentes de tuberculose, utilizando o instrumento Primary Care Assessment Tool. Análise estatística com Teste Qui-quadrado (p < 0,05). Em relação à porta de entrada, notou-se que o serviço de saúde mais procurado foi Atenção Básica (37,6%); a maioria dos diagnósticos ocorreu nas Unidades de Referência do Programa de Controle da Tuberculose (61,3%). Houve evidência de associação entre primeiro serviço de saúde procurado e fatores tempo de demora na obtenção de consulta neste (p = 0,0182), hipótese diagnóstica feita pelo primeiro serviço de saúde procurado (p = 0,0001), solicitação exame de escarro (p = 0,0003), solicitação exame de Raios-X (p = 0,0159), encaminhamento para Raios-X em outro serviço (p = 0,0001), diagnóstico pelo mesmo serviço de saúde (p = 0,0001), exames realizados no próprio serviço de saúde que diagnosticou tuberculose (p = 0,0018), proximidade do domicílio (p = 0,0001). Portanto, a identificação de lacunas importantes na acessibilidade ao diagnóstico de tuberculose parece estar relacionada às dificuldades operacionais de organização da atenção à saúde.

This study sought to assess the accessibility to the diagnosis of tuberculosis in health services in Victoria, state of Espírito Santo. It featured a cross-sectional study conducted in 2009 of patients with tuberculosis using the Primary Care Assessment Tool and statistical analysis with the Chi-square test (p <0,05). In relation to initial access to care, it was seen that the health service of first access most sought was Primary Care (37.6%), with most diagnoses occurring in the Tuberculosis Control Program Reference Units (61.3%). There was evidence of association between first health service accessed and the factors of time delay in: obtaining consultation at the first health service sought (p = 0.0182); diagnosis made by the first health service sought (p = 0.0001); request for sputum exam (p = 0,0003); request for X-ray exams (p = 0.0159); referral for X-rays at another institution (p = 0.0001); diagnosis by the same health service (p = 0.0001); exams conducted by the same health service that initially diagnosed tuberculosis (p = 0.0018); and proximity to the home (p = 0.0001). Therefore, the identification of important gaps in accessibility to diagnosis of tuberculosis seems to be related to the operational difficulties of organization of health care.