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Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil.

ABSTRACT: In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemographic, epidemiological and clinical variables were analyzed. Relative risk (RR) estimates for hospitalization and death were determined by regression models. There were 2,419 co-infection cases, of which 1,527 (63.1%) corresponded to hospitalizations, and 662 (27.4%) to death. The occurrence of hospitalization was associated with ? 7 years of schooling (RR = 3.47, 95%CI: 1.97-6.29), 8-11 years of schooling (RR = 2.56, 95%CI: 1.44-4.69), place of origin-district health authorities Northwest/Humaitá/Navegantes/Ilhas (RR = 2.01, 95%CI: 1.44-2.82), type of entry into the surveillance system as in cases of reentry after withdrawal (RR = 1,35, 95%CI: 1.07-1.70), closure in surveillance as in withdrawal of treatment (RR = 1.47, 95%CI: 1.18-1.83) and multidrug-resistant tuberculosis (RR = 3.94, 95%CI: 1.97-8.81). The occurrence of death was associated with age (RR = 1.07, 95%CI: 1,01-1,14), ? 7 years of schooling (RR = 3.94, 95%CI: 2.26-7.09), 8-11 years of schooling (RR = 2.84, 95%CI: 1.61-5.16), place of origin-district health authorities Baltazar (RR = 2.05, 95%CI: 1.48-2.86), type of entry in the surveillance system as cases of re-entry after withdrawal (RR = 1.53, 95%CI: 1.22-1.91), relapse (RR = 1.33, 95%CI: 1.03-1.73). The occurrence of hospitalizations and deaths is high among co-infected patients. Our estimation approach is important in order to identify, from the surveillance data, the risk factors for hospitalization and death in co-infected patients, so that they may receive more attention from the Brazilian national healthcare system.

SUBMITTER: Rossetto M

PROVIDER: S-EPMC6314623 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil.

Rossetto Maíra M Brand Évelin Maria ÉM Rodrigues Renata Mendonça RM Serrant Laura L Teixeira Luciana Barcellos LB

PloS one 20190102 1

In locations with a high rate of tuberculosis (TB) and HIV infection, there are a number of strategies to prevent negative outcomes such as opportunistic infections, hospitalizations and death, and this article investigates risk factors for the occurrence of hospitalization and death in cases of TB/HIV co-infection in the south of Brazil. The data are taken from a population-based retrospective cohort study on cases of TB/HIV co-infection from 2009 to 2013 in Porto Alegre, Brazil. Sociodemograph ...[more]

PMID: 30601842

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Project description:BACKGROUND:TB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil. METHODS:A retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT. RESULTS:2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08-1.54), cases of relapse (OR = 1.33; 95% CI = 1.03-1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20-1.83), transfer (OR = 2.04; 95% CI = 1.40-2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24-2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16-1.67), and mental disorders (OR = 1.83; 95% CI = 1.38-2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%. CONCLUSIONS:There was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.

Dataset Information

Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil.

Publications

Factors associated with hospitalization and death among TB/HIV co-infected persons in Porto Alegre, Brazil.

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