title: Tuberculosis control in a highly endemic indigenous community in Brazil.
abstract: In Latin America, indigenous populations have high rates of non-completion of TB treatment and case fatality and have been defined as a priority group for investments. To evaluate TB control, a retrospective cohort study was performed to identify factors predictive of non-completion of treatment and mortality in an indigenous and non-indigenous population between 2002 and 2008 in Dourados, Brazil. A 90% reduction in non-completion of TB treatment was observed in the indigenous population after DOTS (directly observed treatment, short course) implementation (20% vs 2%). In the non-indigenous population, the number of patients not completing TB treatment continued to increase. Non-indigenous TB patients had 4.5 times higher mortality than indigenous TB patients (9% vs 2%). In multivariate analysis, non-indigenous race [odds ratio (OR) 2.33, 95% CI 1.32-4.10] was associated with non-completion of TB treatment, and HIV-positive status (OR 5.58, 95% CI 2.38-13.07) was associated with mortality. Implementation of DOTS in the indigenous populations in Dourados showed a significant reduction in non-completion of TB treatment. Nevertheless, a high rate of TB in children and young adults indicates the continuous transmission and maintenance of the epidemic in this community. Among the non-indigenous population, the TB case fatality rate is closely linked to the HIV prevalence.
authors.affiliation: University Hospital, Federal University of Grande Dourados, Dourados, Brazil.
authors.forename: Mariana Garcia
authors.initials: MG
authors.lastname: Croda
authors.forename: Zelik
authors.initials: Z
authors.lastname: Trajber
authors.forename: Rosangela da Costa
authors.initials: Rda C
authors.lastname: Lima
authors.forename: Julio
authors.initials: J
authors.lastname: Croda
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D023801:Directly Observed Therapy; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D044382:Population Groups / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D016903:Drug Monitoring