Fatores associados à tuberculose drogarresistente no Estado do Maranhão, no período de 2010 a 2015.

Abstract

Drug-resistant tuberculosis (TBDR) is currently a major public health problem. TBDR is caused by Mycobacterium tuberculosis resistant to more than one of the major antituberculosis drugs, especially rifampicin (R) and isoniazid (H). The objective is to investigate the factors associated with TBDR in the state of Maranhão. A cross-sectional retrospective analytical study of TBDR cases was performed. The study population included the TBDR cases residing in Maranhão, and reported in the Special Tuberculosis Treatment Information System (SITETB) in the period from 2010 to 2015. Data were collected from the SITETB database and the Information of Notification Diseases (SINAN) of the Department of Health of Maranhão, from June to August 2017. The following variables were used: year of notification, sex, age, race, education, occupation, origin, clinical form, place of contagion, HIV test, closure, type of resistance, resistance pattern, resistance or sensitivity ofloxacin, ethambutol, ethionamide, amikacin, rifampicin, isoniazid, streptomycin, capreomycin and kanamycin), treatment regimen, sputum smear microscopy, sputum culture, X-ray and associated comorbidities. Poisson regression was used. The prevalence ratios (PR) and their respective 95% confidence intervals (95% CI) were estimated. In the study period, 10,944 cases of tuberculosis were reported in the State of Maranhão, of which 10,820 (98.9%) cases of sensitive TB and 124 (1.13%) cases with TBDR. The highest number of cases was in 2013 (27 cases) and the lowest in 2010 (3 cases). TBDR was more frequent in males (63.7%), in the age group 20-39 years old (52.4%), non-white race / color (87.9%), schooling with ≥ 8 years of schooling (49.2%), unemployed (60.5%) and from the state capital (58.1%). In the unadjusted analysis it was observed that the schooling level <8 years (95% CI = 0.31-0.64, OR = 0.44, p <0.001), the retreatment entry (95% CI = 1.71- (CI 95% = 2.15-4.41, OR = 3.08, p <0.001), positive sputum smear microscopy (95% CI = 3.86, OR = 2.56, p <0.001) (95% CI = 0.08-0.79, OR = 0.25, p = 0.019), had positive HIV test (95% CI = 0.08-0.79, OR = 0.25, p = (95% CI = 0.09-0.91, OR = 0.29, p = 0.035), and had a 95% CI = 0.17-1.02, OR = 0.42, p = 0.057), to use illicit drugs (95% CI = 1.01-2.71, OR = 1.66, p = 0.043) were associated with TBDR. After adjustment of the model, only the schooling level <8 years (95% CI = 0.32-0.66, OR = 0.46, p <0.001), the retreatment entry (95% CI = 1.05-2.48; OR = 1.61, p = 0.030), closure did not cure (95% CI = 2.01-4.35, OR = 2.96, p <0.001), and positive sputum smear microscopy (95% CI = 26-8, 87, OR = 4.47, p <0.001) were associated with TBDR. It is concluded that the prevalence of TBDR in Maranhão is low, and it is clear that having entry through retreatment, closure due to non-cure and positive bacilloscopy, may be contributing to the maintenance of this rate.