Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile

Antunes, Luize Barbosa; Andrade, Rubia Laine de Paula; Ribeiro, Roberta Ramos; Monroe, Aline Aparecida; Signor, Eduarda; Bianchini, Aniele Silveira Machado de Oliveira; Veira, Nayara Figueiredo; Gonzales, Roxana Isabel Cardozo

doi:10.1590/1983-1447.2024.20230127.en

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Revista Gaúcha de Enfermagem

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Original Article • Rev. Gaúcha Enferm. 45 • 2024 • https://doi.org/10.1590/1983-1447.2024.20230127.en copy

Tuberculosis treatment during the COVID-19 pandemic: actions offered and case profile

Tratamiento de Tuberculosis durante Pandemia de COVID 19: acciones ofrecidas y perfil de casos

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the association between the provision of tuberculosis treatment actions and the sociodemographic and clinical characteristics of cases during the COVID-19 pandemic.

Method:

Cross-sectional study conducted with data from secondary sources of 134 tuberculosis cases that underwent treatment in 2020 in the city of Pelotas, RS, Brazil. Data were analyzed using descriptive statistics, Chi-square test, and Fisher’s exact test.

Results:

The least frequently offered actions in the period were: three or more control smear microscopies (12.7%), smear microscopy at the end of treatment (16.7%), chest X-ray at sixth month (48.5%) and sputum culture (49%). The number of medical and nursing consultations did not reach six in 52.9% and 83.3% of cases, respectively. The lower offer of treatment actions was associated with: retreatment (p<0.001); comorbidities (p=0.023); HIV infection (p<0.001); mental disorder (p=0.013); illicit substance use (p=0.018); normal chest X-ray (p=0.024); and special treatment regimen (p=0.009).

Conclusion:

After the COVID-19 pandemic, it is essential to invest in cases follow-up, especially those undergoing retreatment, with comorbidities, drug use, normal chest X-ray results, and special treatment regimens.

Descriptors:
Tuberculosis; Therapeutics; COVID-19; Health services accessibility

Variable	Pulmonary*	Extrapulmonary
Variable	n(%)	n(%)
HIV testing
Yes	89 (87.3%)	28 (87.5%)
No	13 (12.7%)	4 (12.5%)
Syphilis testing
Yes	75 (73.5%)	26 (81.5%)
No	27 (26.5%)	6 (18.8%)
Hepatitis B testing
Yes	79 (77.5%)	27 (84.4%)
No	23 (22.5%)	5 (15.6%)
Hepatitis C testing
Yes	78 (76.5%)	27 (84.4%)
No	24 (23.5%)	5 (15.6%)
Chest X-ray at 2nd month
Yes	87 (85.3%)	21 (65.6%)
No	15 (14.7%)	11 (34.4%)
Chest X-ray at 6th month
Yes	52 (51%)	13 (40.6%)
No	50 (49%)	19 (59.4%)
Sputum culture^#
Yes	50 (49%)	--
No	52 (51%)	--
Sputum smear microscopy for control^#
Zero	56 (54.9%)	--
One to two	33 (32.4%)	--
Three or more	13 (12.7%)	--
Sputum smear microscopy at the end of treatment^#
Yes	17 (16.7%)	--
No	85 (83.3%)	--
Medical consultations
One to five	54 (52.9%)	16 (50%)
Six or more	48 (47.1%)	16 (50%)
Nursing consultations
One to five	85 (83.3%)	26 (81.3%)
Six or more	17 (16.7%)	6 (18.8%)
Dispensing of anti-TB drugs
One to five	28 (27.5%)	6 (18.8%)
Six or more	74 (72.5%)	26 (81.3%)

Variable	Pulmonary				Extrapulmonary
Variable	Mean	Median (IQR)	Min.	Max.	Mean	Median(IQR)	Min.	Max.
Sputum smears tests for control^#	0.9	0(0-2)	0	7	--	--	--	--
Medical consultations	5.3	5(4-7)	0	13	5.5	5.5(2-8)	1	11
Nursing consultations	2.5	1(1-4)	0	9	2.1	1.5(0-3.5)	0	7
Dispensing of anti-TB drugs	5.7	6(5-6)	1	12	5.9	6(6-6)	2	12

Variable	Lower Offer	Greater Offer	p-value
Variable	n(%)	n(%)	p-value
Gender^*
Female	23 (53.5%)	20 (46.5%)	0.579
Male	44 (48.4%)	47 (51.6%)	0.579
Age group^*
18 to 24 years old	13 (41.9%)	18 (58.1%)	0.335
25 to 39 years old	20 (58.8%)	14 (41.2%)
40 to 59 years old	26 (54.2%)	22 (45.8%)
60 years old or more	8 (38.1%)	13 (61.9%)
Occupation^** (n=115)^#
Retired	12 (60.0%)	8 (40.0%)	0.419
Self-employed	15 (60.0%)	10 (40.0%)
Home/Student	3 (50.0%)	3 (50.0%)
Employed	15 (38.5%)	24 (61.5%)
No occupation	12 (48.0%)	13 (52.0%)
Education level** (n=131)^#
Not literate	3 (75.0%)	1 (25.0%)	0.396
Incomplete elementary	48 (53.3%)	42 (46.7%)
Complete elementary	4 (50.0%)	4 (50.0%)
High School	8 (34.8%)	15 (65.2%)
Complete higher education	2 (33.3%)	4 (66.7%)
Skin color^*
White	45 (53.6%)	39 (46.4%)	0.284
Black/Brown	22 (44.0%)	28 (56.0%)	0.284
Special population^*
Yes	6 (60.0%)	4 (40.0%)	0.511
No	61 (49.2%)	63 (50.8%)	0.511
Government income transfer program beneficiary**
Yes	5 (71.4%)	2 (28.6%)	0.441
No	62 (48.8%)	65 (51.2%)	0.441

Variable	Lower Offer	Greater Offer	p-value
Variable	n(%)	n(%)	p-value
Type of entry to the outpatient clinic^*
New case	23 (33.3%)-	46 (66.7%)+	<0.001
Retreatment	19 (79.2%)+	5 (20.8%)-
Transfer	25 (61.0%)	16 (39.0%)
Comorbidities^*
Yes	53 (56.4%)+	41 (43.6%)-	0.023
No	14 (35.0%)-	26 (65.0%)+	0.023
HIV^*
Yes	18 (90.0%)+	2 (10.0%)-	<0.001
No	49 (43.0%)-	65 (57.0%)+	<0.001
Diabetes^*
Yes	5 (31.3%)	11 (68.8%)	0.110
No	62 (52.5%)	56 (47.5%)	0.110
Mental disorder^**
Yes	7 (100%)+	0-	0.013
No	60 (47.2%)-	67 (52.8%)+	0.013
Alcohol use^*
Yes	20 (64.5%)	11 (35.5%)	0.065
No	47 (45.6%)	56 (54.4%)	0.065
Tobacco use^*
Yes	33 (53.2%)	29 (46.8%)	0.488
No	34 (47.2%)	38 (52.8%)	0.488
Use of illicit substances^*
Yes	19 (70.4%)+	8 (29.6%)-	0.018
No	48 (44.9%)-	59 (55.1%)+	0.018
Result of initial chest x-ray^** (n=107)^#
Suspicion	47 (46.1%)-	55 (53.9%)+	0.024
Normal	5 (100%)+	0-	0.024
Result of diagnostic sputum smear microscopy^**(n=77)^#
Positive	34 (46.6%)	39 (53.4%)	0.125
Negative	0	4 (100%)	0.125
Pharmacological treatment regimen for TB^*
Basic	56 (46.3%)-	65 (53.8%)+	0.009
Special	11 (84.6%)+	2 (15.4%)-	0.009

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[1] Corresponding author:
Roberta Ramos Ribeiro E-mail: robertaribeiro@discente.ufg.br