Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context
Summary: Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable t...
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Elsevier
2024-12-01
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| Series: | The Lancet Regional Health. Americas |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X24002655 |
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| author | Victor Santana Santos Jamile Rodrigues Cosme de Holanda Ruy Dantas Silveira Gois-Neto Ethel Leonor Noia Maciel Fernanda Dockhorn Costa Johansen José Nildo de Barros Silva-Júnior Wesley Adson Costa Coelho Correio José Roberto Lapa e Silva José Rodrigo Santos Silva Ricardo Queiroz Gurgel Tom Wingfield |
| author_facet | Victor Santana Santos Jamile Rodrigues Cosme de Holanda Ruy Dantas Silveira Gois-Neto Ethel Leonor Noia Maciel Fernanda Dockhorn Costa Johansen José Nildo de Barros Silva-Júnior Wesley Adson Costa Coelho Correio José Roberto Lapa e Silva José Rodrigo Santos Silva Ricardo Queiroz Gurgel Tom Wingfield |
| author_sort | Victor Santana Santos |
| collection | DOAJ |
| description | Summary: Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. Methods: We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. Findings: A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9). Interpretation: In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Funding: Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK. |
| format | Article |
| id | doaj-art-3ffdae52a0be41c7ad04a16d4e8c1fa8 |
| institution | Kabale University |
| issn | 2667-193X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-3ffdae52a0be41c7ad04a16d4e8c1fa82024-11-15T06:15:29ZengElsevierThe Lancet Regional Health. Americas2667-193X2024-12-0140100938Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in contextVictor Santana Santos0Jamile Rodrigues Cosme de Holanda1Ruy Dantas Silveira Gois-Neto2Ethel Leonor Noia Maciel3Fernanda Dockhorn Costa Johansen4José Nildo de Barros Silva-Júnior5Wesley Adson Costa Coelho Correio6José Roberto Lapa e Silva7José Rodrigo Santos Silva8Ricardo Queiroz Gurgel9Tom Wingfield10Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Department of Medicine, Federal University of Sergipe, Lagarto, Brazil; Corresponding author. Departamento de Medicina, Universidade Federal de Sergipe, Campus Lagarto, Av. Gov. Marcelo Deda, s/n, São José, Lagarto, Sergipe, 49400–000, Brazil.Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, BrazilDepartment of Medicine, Federal University of Sergipe, Lagarto, BrazilDepartment of Nursing, Federal University of Espírito Santos, Vitória, BrazilSecretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, BrazilSecretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, DF, BrazilFACENE, Mossoró, BrazilGraduate Program of Clinical Medicine, Federal University of Rio de Janeiro and Graduate Program of Medical Sciences, Fluminense Federal University, BrazilDepartment of Statistics and Actuarial Sciences, Federal University of Sergipe, São Cristóvão, BrazilHealth Sciences Graduate Program, Federal University of Sergipe, Aracaju, Brazil; Department of Medicine, Federal University of Sergipe, Aracaju, BrazilCentre for Tuberculosis Research, Departments of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UKSummary: Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. Methods: We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. Findings: A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9). Interpretation: In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Funding: Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.http://www.sciencedirect.com/science/article/pii/S2667193X24002655TuberculosisSocial and health factorsUnfavourable treatment outcomesChild and adolescent health |
| spellingShingle | Victor Santana Santos Jamile Rodrigues Cosme de Holanda Ruy Dantas Silveira Gois-Neto Ethel Leonor Noia Maciel Fernanda Dockhorn Costa Johansen José Nildo de Barros Silva-Júnior Wesley Adson Costa Coelho Correio José Roberto Lapa e Silva José Rodrigo Santos Silva Ricardo Queiroz Gurgel Tom Wingfield Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context The Lancet Regional Health. Americas Tuberculosis Social and health factors Unfavourable treatment outcomes Child and adolescent health |
| title | Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context |
| title_full | Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context |
| title_fullStr | Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context |
| title_full_unstemmed | Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context |
| title_short | Social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug-sensitive tuberculosis in Brazil: a national retrospective cohort studyResearch in context |
| title_sort | social and health factors associated with unfavourable treatment outcomes in children and adolescents with drug sensitive tuberculosis in brazil a national retrospective cohort studyresearch in context |
| topic | Tuberculosis Social and health factors Unfavourable treatment outcomes Child and adolescent health |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X24002655 |
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