Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort

Autoři: Évelin Maria Brand aff001;  Maíra Rossetto aff002;  Karen da Silva Calvo aff001;  Gerson Barreto Winkler aff001;  Daila Alena Raenck da Silva aff003;  Bruna Hentges aff004;  Frederico Viana Machado aff001;  Erica Rosalba Mallmann Duarte aff003;  Lucas Cardoso da Silva aff001;  Samantha Correa Vasques aff001;  Luciana Barcellos Teixeira aff001
Působiště autorů: Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil aff001;  Department of Medicine, Universidade Federal da Fronteira Sul, Chapecó, Santa Catarina, Brazil aff002;  Department of Professional Assistance and Guidance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil aff003;  Department of Social Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222786



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.


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.


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%.


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.

Klíčová slova:

Brazil – Co-infections – Drug therapy – HIV – HIV diagnosis and management – Sputum – Tuberculosis – Tuberculosis diagnosis and management


1. Souza W. Neglected diseases. Rio de Janeiro: Brazilian Academy of Sciences; 2010.

2. World Health Organization. Global tuberculosis report 2015. Geneva: WHO; 2015.

3. World Health Organization. Global tuberculosis report 2018. Geneva: WHO; 2018.

4. Pan American Health Organization. Tuberculosis in the Americas 2018. Washington; 2018.

5. Brasil. Ministry of Health. Secretariat of Health Surveillance. Department of Surveillance of Communicable Diseases. National plan for the end of tuberculosis. Brasília: Ministry of Health; 2017.

6. Brasil. Ministry of Health. Secretariat of Health Surveillance. TB-HIV Coinfection in Brasil: epidemiological overview and collaborative activities. Epidemiological Bulletin, Brasília. 2017;48:40

7. Basta PC, Marques M, Oliveira RL, Cunha EAT, Resendes APC, Souza-Santos R. Social inequalities and tuberculosis: an analysis by race/color in Mato Grosso do Sul, Brazil. Rev Saúde Pública. 2013;47(5):854–864. http://dx.doi.org/10.1590/S0034-8910.2013047004628

8. Li Q, Zhao G, Wuet L, Lu M, Liu W, Wu Y et al. Prevalence and patterns of drug resistance among pulmonary tuberculosis patients in Hangzhou, China. Antimicrobial Resistance and Infection Control. 2018;7(61):1–6.

9. Fekadu S, Teshome W, Alemu G. Prevalence and determinants of Tuberculosis among HIV infected patients in south Ethiopia. J Infect Dev Ctries. 2015;9(8):898–904. doi: 10.3855/jidc.5667 26322884

10. Yamamura M, Santos Neto M, Freitas IM, Rodrigues LBB, Popolin MP, Uchoa SAC, et al. Tuberculose e iniquidade social em saúde: uma análise ecológica utilizando técnicas estatísticas multivariadas, São Paulo, Brasil. Rev Panam Salud Publica. 2014;35(4):270–7.

11. Brasil. Ministry of Health. Executive Secretariat. Recommendations for the management of TB-HIV co-infection in specialized care services for people living with HIV / AIDS. Brasília: Ministry of Health; 2013.

12. Prado TN et al. Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in TB-HIV co-infected patients in Brazil: a hierarchical polytomous analysis. Braz J Infect Dis. 2017; 21(2):162–170. doi: 10.1016/j.bjid.2016.11.006 27936379

13. Santos JN, Sales CMM, Prado TN, Maciel EL. Fatores associados à cura no tratamento da tuberculose no estado do Rio de Janeiro, 2011–2014. Epidemiol. Serv. Saúde. 2018 27(3):e2017464. http://dx.doi.org/10.5123/s1679-49742018000300015 30365701

14. Rossetto M, Brand EM, Rodrigues RM, Serrant L, Teixeira LB. Factors associated with hospitalization and death among TB/HIV coinfected persons in Porto Alegre, Brazil. PLoS ONE. 2019; 14(1): e0209174. https://doi.org/10.1371/journal 30601842

15. Rothman KJ, Greeland S, Lash TL. Modern Epidemiology. 3rd ed. Porto Alegre: Artmed; 2011.

16. Brasil. Notification of Injury Information System. 2018. http://portalsinan.saude.gov.br/. Accessed 25 Jun 2018.

17. Brasil. Mortality Information System. 2018. http://www2.datasus.gov.br/DATASUS/index.php?area=060701. Accessed 25 Jun 2018.

18. Porto Alegre. Municipal Health Plan 2018 to 2021. Porto Alegre: City Hall of Porto Alegre; 2017.

19. Brazil. Resolution n° 466 of December 12, 2012. Brasília: Ministry of Health; 2012. http://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html. Accessed 13 Mar 2018.

20. World Health Organization. The End TB Strategy. Geneva, Switzerland: 2017. https://www.who.int/tb/End_TB_brochure.pdf. Accessed 04 Jul 2018.

21. Alipanah N, Jarlsberg L, Miller C, Linh NN, Falzon D, Jaramillo E, Nahid P. Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS Med. 2018;15(7):e1002595. doi: 10.1371/journal.pmed.1002595 29969463

22. World Health Organization. Global tuberculosis control 2011. Geneva, Switzerland: Dec. 2011.

23. Peruhype RC, Acosta LMW, Ruffino-Netto A, Oliveira MMC, Palha PF. Distribuição da tuberculose em Porto Alegre: análise da magnitude e coinfecção tuberculose-HIV. Rev esc enferm USP. 2014;48(6):1035–43.

24. Anand T, Sharma N, Chandra S, Ingle GK, Grover S. Decadal impact of Directly Observed Treatment Short course program on age and gender among New Infectious Tuberculosis cases in Delhi. Indian J Tuberculosis. 2017;64(4): 291–295.

25. Woimo TT, Yimer WK, Bati T, Gesesew HA. The prevalence and factors associated for anti-tuberculosis treatment non-adherence among pulmonary tuberculosis patients in public health care facilities in South Ethiopia: a cross-sectional study. BMC Public Health. 2017;17(269):1–10.

26. Rio Grande do Sul. State Department of Health. State Center for Health Surveillance. Epidemiological Surveillance Division. The State Plan for Tuberculosis Control.Porto Alegre;2010. http://www.saude.rs.gov.br/upload/1339784445_Plano%20Estadual%20de%20Controle%20da%20Tuberculose.pdf. Acessed 11 Jun 2017.

27. Brazil. Ministry of Health. Basic Attention Department. History of Family Health Coverage. Brazil; 2017. http://dab.saude.gov.br/portaldab/historico_cobertura_sf.php. Acessed 02 Jul 2017

28. Zambenedetti G, Silva RAN. Decentralization of attention in HIV-AIDS to basic care: tensions and potentialities. Physis: Rev Saud Colet;26(3):785–806.

29. Porto Alegre. Municipal Health Department of Porto Alegre. General Coordination of Health Surveillance. Communicable Disease Surveillance Team. Epidemiological Bulletin 59. Porto Alegre; 2015.

30. Riley LW, Ko AI, Unger A, Reis MG. Slum health: diseases of neglected populations. BMC Int Health Hum Rights. 2007;7:2. doi: 10.1186/1472-698X-7-2 17343758

31. Snyder RE, Marlow MA, Phuphanich ME, Riley LW, Maciel EL. Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: a retrospective cohort study. BMC Infect Dis. 2016;16:494. doi: 10.1186/s12879-016-1835-1 27647383

32. Gonzalez C, Sáenz C, Herrmann E, Jajati M, Kaplan P, Monzón D. Tratamiento directamente observado de la tuberculosis en un hospital de la Ciudad de Buenos Aires. Medicina (B. Aires). 2012;72(5):371–9.

33. Satti SBR, Kondagunta N. Risk factors for DOTS treatment default among new HIVTB coinfected patients in Nalgonda (dist.) Telagana (state): a case control study. Indian J Community Med. 2016;41(2):120–5. doi: 10.4103/0970-0218.177529 27051086

34. Maffacciolli R, Oliveira DLLC, Brand EM. Vulnerability and human rights in the understanding of trajectories of hospitalization for tuberculosis. Saúde e Sociedade. 2017;26(1):286–99.

35. Kapata N, ChandaKapata P, Michelo C: The social determinants of tuberculosis and their association with TB/HIV co-infection in Lusaka, Zambia. Med J Zambia. 2013;40:2.

36. Méda ZC, Sombié I, Sanon OWC, Maré D, Morisky DE, Chen YMA. Risk factors of tuberculosis infection among HIV/AIDS patients in Burkina Faso. Aids Res Hum Retro. 2013;29(7):1045–55

37. Oliveira NF, Gonçalves MJF. Social and environmental factors associated with the hospitalization of patients with tuberculosis. Rev Latinoam Enfermagem. 2013;21(2):1–8.

38. Abreu GRF, Figueiredo MAA. Abandonment of tuberculosis treatment in Salvador, Bahia—2005–2009. Rev Baiana Saúd Públic. 2013;37(2): 407–22.

39. Harling G, Lima Neto AS, Sousa GS, Machado MMT, Castro MC. Determinants of tuberculosis transmission and treatment abandonment in Fortaleza, Brazil. BMC Public Health. 2017;17:508. doi: 10.1186/s12889-017-4435-0 28545423

40. Brazil. Ministry of Health. Secretariat of Health Surveillance. National Program for Tuberculosis Control. Manual of recommendations for the control of tuberculosis in Brazil. Brasília: Ministry of Health; 2011.

41. Coelho A, Biberg C. Tuberculosis / HIV coinfection profile in the municipality of São Luís, Maranhão, Brazil. Cadernos ESP. 2015;9(1):19–26.

42. Nast K. The scenario of supervised treatment of tuberculosis in the city of Porto Alegre: actions and approaches to health promotion. Porto Alegre. Dissertation [Master’s Degree in Nursing]—Federal University of Rio Grande do Sul; 2014.

43. Câmara JT, Menezes JB, Pereira BM, Oliveira TRC, Oliveira TMP, Ribeiro NS. Epidemiological profile of patients diagnosed with resistance to Mycobacterium tuberculosis. Rev enferm UFPE. 2016;10(11):4082–9.

44. Fregona G, Cosme LB, Moreira CMM, Bussular JL, Dettoni VV, Dalcolmo MP, et al. Risk factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil. Rev Saúd Públic. 2017;51(41):1–11.

45. Javaid A, Ullah I, Masud H, Basit A, Ahmad W, Butt ZA, Qasim M, Predictors of poor treatment outcomes in multidrug-resistant tuberculosis patients: A retrospective cohort study. Clin Microbiol Infect. 2017;24(6):612–617. doi: 10.1016/j.cmi.2017.09.012 28970158

46. Agbor AA, Bigna JJR, Billong SC, Tejiokem MC, Ekali GL, Plottel CS, et al. Factors associated with death during tuberculosis treatment of patients co-infected with HIV at the Yaoundé Central Hospital, Cameroon: an 8-Year hospital-based retrospective cohort study (2006–2013). PLoS One. 2014;9(12):1–22.

47. Gesesew H, Tsehaineh B, Massa D, Tesfay A, Kahsay H, Mwanri L. Predictors of mortality in a cohort of tuberculosis/HIV co-infected patients in Southwest Ethiopia. Infectious Diseases of Poverty. 2016;5(109):1–9.

Článek vyšel v časopise


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.


Nemáte účet?  Registrujte se