Aspectos clínico-epidemiológicos e distribuição espacial da coinfecção tuberculose/HIV em município do Nordeste brasileiro

Abstract

Scientific investigations related to tuberculosis/HIV co-infection have been stimulated as they are important instruments for case surveillance and detection of failures by

health systems and services. In this sense, the objective was to analyze the clinical- epidemiological aspects of tuberculosis/HIV co-infection and its spatial distribution in

Imperatriz (MA, Brazil). This is an ecological study with different measures of analysis, carried out with data from the Notifiable Diseases Information System, relating to tuberculosis cases associated with the HIV disease, registered between 2006 and 2017. The data were collected in January 2020 from to the Health Surveillance Service of the Regional Health Management Unit of Imperatriz. The prevalence rates of coinfection each year and the average for the period were determined, and the trend analysis was performed using the Prais-Winsten

regression. A descriptive analysis of the sociodemographic and clinical- epidemiological variables was performed in relation to the outcome (anti-HIV) and for

the identification of factors associated with co-infection, Poisson regression models were processed using the software Statistical Package for Social Sciences version 24.0, setting a 5%, with prevalence ratios and respective 95% confidence intervals being determined. The cases were geocoded using TerraView software version 4.2.2 and the Batch Geocode tool. Kernel analysis and spatial scanning were performed, and the maps were made using ArcGis 10.5 software. Research approved by Committee for Ethics in Research of Universidade Federal do Maranhão under protocol 2,159,911. We found 947 tuberculosis cases registered with Notifiable Diseases Information System, of which 394 (41.6%) did not undergo the anti-HIV test, 52 (5.5%) met with an ongoing test, and 501 (52.9 %) performed the test; of these, 73 were positive for HIV. The prevalence of coinfection ranged from 1.5%, in 2016, to 44.4%, in 2007, with an average of 20.0%, and showed a downward trend over the period. The variables male gender, urban area, entry due to relapse and closure due to treatment abandonment remained associated with co-infection (p<0.05). The spatial distribution of the cases was heterogeneous, ranging from 0.00 to 5.74 cases/km2

, restricted to the urban area of the scenario, and the scanning analysis detected two spatial clusters of statistically significant high risk (p<0.005) in census tracts in the central part with dispersion to peripheral areas, characterized by territorial expansion, high population density and marked socio-spatial inequalities. Such findings raise the need for the implementation of effective measures by public management and health systems and services, to reduce social inequalities and to carry out permanent training for health professionals, both for clinical management and for updating health care registration and systems, in addition to intersectoral articulations of tuberculosis and HIV programs, in an attempt to approximate the goals of eliminating both diseases agreed upon by competent health agencies.