Determinantes sociais da saúde e cobertura de estratégia de saúde da família no tratamento diretamente observado da tuberculose: uma análise hierárquica de dados longitudinais no Brasil nos anos de 2014 a 2016

Abstract

Introduction: The complexity of tuberculosis (TB) control and replacement transits through several aspects such as the social determinants of TB health (DSS-TB). Treatment adherence strategies such as Direct Observed Treatment (DOT) and health services capable of receiving, diagnosing, treating individuals, such as the Family Health Strategy (FHS) are used. Objective: To analyze the DSS-TB and the contribution of ESF coverage to the DOT in Brazil. Methods: Longitudinal database study of TB cases reported in the Brazilian Notification Disease Information System (SINAN) between 2014 and 2016. We included individuals older than 18 years and excluded individuals with post-death notification who did not have DOT information. For bivariate analysis we used Person's chi-square test and for multivariate analysis we used hierarchical logistic regression, in which ODD was the dependent variable and the predictor variables were analyzed in levels. A second analysis was performed based on the stratification of the sample, according to the FHS coverage of the municipalities where the individuals lived. Results: 252,675 people with TB were notified at SINAN. 13,744 individuals under 18 years of age, 1,365 with post- death notification and 59,940 individuals with no DOT information were excluded. 88,586 (49.8%) performed DOT and 89,040 (50.1%) did not perform DOT. Have more than 8 years of study (OR 0.45, 95% CI 0.41–0.49), live in the Northeast (OR 0.49 95% CI 0.46–0.51), be health professionals (OR 0.77, 95% CI 0.65–0.91) and living with HIV / AIDS (OR 0.69, 95% CI 0.65–0.73) are less likely to have DOT. Individuals deprived of liberty (OR 1.21, 95% CI 1.12–1.32), alcoholism (OR 1.09, 95% CI 1.03–1.16), mental disorder (OR 1.17, 95% CI 1.04–1.32) and positive sputum smear (OR 1.15, CI 95% 1.10–1.21) were more likely to perform DOT. In stratification by FHS coverage, homeless individuals (OR 1.02, 95% CI 0.76–1.36), alcoholism (OR 1.15, 95% CI 0.98–1.09), illicit drug use (OR 1.12, 95% CI 0.97– 1.29), smoking (OR 1.00, 95% CI 0.90–1.10), mental disorder (OR 1.22, 95% CI 0.95–1.56) and positive sputum smear (OR 1.10, 95% CI 1.00–1.20) did not show statistical significance in > 70% FHS coverage. Discussion: The performance of DOT in Brazil is associated with DSS-TB. However, there is a decrease in this association when we analyze the individuals of the platform with more than 70% of FHS coverage, suggesting a decrease in selection by the vulnerabilities of individuals to perform DOT in the largest FHS coverage. Conclusion: This study has the potential to contribute to the discussion of the strengthening of DOT in Brazil as well as to foster the importance of the FHS in performing DOT. Further studies are needed to evaluate the participation of FHS teams in the diagnosis and treatment of individuals.