Latent Tuberculosis Infection Diagnostic and Treatment Cascade among Contacts in Primary Health Care in a City of Sao Paulo State, Brazil: Cross-Sectional Study.
BACKGROUND
Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management.


OBJECTIVE
To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto-SP, Brazil.


METHODS
Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed.


RESULTS
Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified.


CONCLUSIONS
There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.
College of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Mato Grosso do Sul, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Anneliese Domingues
AD
Wysocki
Department of Public Health, School of Nursing of Ribeirao Preto-University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Tereza Cristina Scatena
TC
Villa
Department of Public Health, School of Nursing of Ribeirao Preto-University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Tiemi
T
Arakawa
Department of Public Health, School of Nursing of Ribeirao Preto-University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Maria Eugênia Firmino
ME
Brunello
Department of Public Health Nursing and Professional Orientation, School of Medicine of Sao Jose do Rio Preto, Sao Jose do Rio Preto, Sao Paulo, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Silvia Helena Figueiredo
SH
Vendramini
Department of Public Health, School of Nursing of Ribeirao Preto-University of São Paulo, Ribeirao Preto, Sao Paulo, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Aline Aparecida
AA
Monroe
Tuberculosis Academic Program, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.|Brazilian Tuberculosis Research Network (Rede TB), Rio de Janeiro, Brazil.
Afranio Lineu
AL
Kritski
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002947:Cities / Q000453:epidemiology; D016358:Contact Tracing / Q000379:methods; D019091:Critical Pathways; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy / Q000635:transmission; D055815:Young Adult