DOTS evaluation in primary health care in Rio de Janeiro

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DOTS evaluation in primary health care in Rio de
Janeiro
Ângela Longo, Carlos Serra, Paulo Henrique de
Almeida Rodrigues, Haroldo Matos Mestrado em
Saúde da Família Universidade Estácio de Sá
Rio de Janeiro
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Introduction
Worldwide Incidence Rate of Tuberculosis Source
WHO, 2000.
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State of Rio de Janeiro - Brasil
92 Counties in the State of Rio de Janeiro with 9
Regions of Health
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Areas of programation in Rio de Janeiro
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Introduction

• Controlling tuberculosis (TB) continues to be a
  goal for Brazil. In the last ten years the
  Brazilian Ministry of Health has made the clear
  decision to decentralize tuberculosis management,
  including the Strategy of Family Health. The
  objective of this study was to evaluate DOTS
  treatment in the primary health setting in Rio de
  Janeiro, Brazil.

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Methods

• A cohort of 529 pulmonary TB patients were
  treated for six months between 2005-2006 using
  DOTS. They were followed in a poor area in the
  outskirts of Rio de Janeiro, the second largest
  city in Brazil. All patients were followed in the
  primary care setting. Two strategies have been
  adopted.

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Methods

• One group, 15, used community health workers who
  went to the patients homes.
• The other group of 85 followed a different
  strategy it was implemented by health
  professionals. In this strategy, patients went to
  primary health centers to receive treatment.

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Results

• Results showed that the overall cure rate of 67.
  The drop-out rate was 19 and the death rate was
  5.
• The remaining 9 were re-oriented to other
  primary heath centers outside our care.
• There was no significant difference between the
  two DOTS strategies adopted so far.

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Results

• The only significant difference was in the
  drop-out rate. Patients who were visited by
  community health workers at their homes were less
  likely to drop-out than patients who went to
  primary health centers.

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Results

• Our analysis of the data from 2007 (plt0,002)
  showed a further reduction in the drop-out rate
  (15). In this case, the strategy with community
  health workers had a significant lower drop-out
  rate among re-treatment cases (plt 0,002).

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Discussion

• Drop-out of treatment continues to be a serious
  problem in TB control. Previous data from the
  areas studied showed that the drop-out rate was
  between 18.8-30.
• The adoption of DOTS in the primary health
  setting has caused a reduction in the drop-out of
  treatment, especially in re-treatment cases.
• The results presented, also points to the
  favorable use of community health workers in
  delivering DOTS.

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Conclusion

• DOTS is an important strategy for controlling TB
  in the primary health setting, in Rio de Janeiro,
  Brazil. Community health workers who visit
  patients at home, are good allies in achieving
  the lowest possible drop-out rate of treatment.
  Efforts for decentralization should be continued
  and enhanced.