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Retreatment and Antituberculosis Therapy Outcomes in Brazil between 2015 and 2022: A Nationwide Study of Disease Registry Data

25 Pages Posted: 7 Dec 2023

See all articles by Beatriz Barreto-Duarte

Beatriz Barreto-Duarte

Universidade Federal do Rio de Janeiro (UFRJ)

Klauss Villalva-Serra

Oswaldo Cruz Foundation (FIOCRUZ) - Gonçalo Moniz Institute (IGM)

João P. Miguez-Pinto

UNIFACS- Universidade Salvador

Mariana Araújo-Pereira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Vanessa M. S. Campos

UNIFACS- Universidade Salvador

Gabriela Rosier

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Betania M. F. Nogueira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Artur T. L. Queiroz

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative

Valeria C. Rolla

Oswaldo Cruz Foundation (FIOCRUZ) - Evandro Chagas National Institute of Infectious Diseases (INI)

Marcelo Cordeiro-Santos

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical

Afranio L. Kritski

Universidade Federal do Rio de Janeiro (UFRJ) - Programa Acadêmico de Tuberculose

Peter F. Rebeiro

Vanderbilt University - Division of Infectious Diseases

Timothy R. Sterling

Vanderbilt University - Division of Infectious Diseases

Moreno M. S. Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Análise e Visualização de Dados

Bruno B. Andrade

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative; Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores

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Abstract

Background: Adherence to anti-tuberculosis treatment (ATT) in Brazil remains a challenge in achieving the goals set forth by the World Health Organization (WHO). Patients who are lost to follow-up (LTFU) during treatment pose a significant public health problem and often receive inadequate attention from the healthcare system when they return for retreatment. Furthermore, there is a lack of knowledge about the factors associated with ATT outcomes in this group. This study aimed to investigate the factors associated with unfavourable ATT outcomes among those undergoing retreatment nationwide in Brazil.

Methods: We conducted an observational study of tuberculosis (TB) cases >18 years-old reported to Brazilian National Notifiable Disease Information System between 2015 and 2022. Only cases with information about the outcome were included in the analyses. Clinical and epidemiologic variables were compared between the study groups (new tuberculosis cases and retreatment). Next, we applied a binomial regression model to identify variables associated with increased risk of any unfavourable outcome (death, failure, or LTFU) and a multinomial regression for each individual ATT outcome (death or LTFU).

Findings: Among 743,823 reported cases of TB in the study period, 594,513 were eligible for inclusion, consisting of 462,061 new TB cases and 93,571 undergoing retreatments (44,642 recurrent and 48,929 retreatments after LTFU [RLTFU]). RLTFU (OR:3·96; 95% CI: 3·83 - 4·1) was a significant risk factor for every unfavourable ATT. Furthermore, RLTFU (OR:4·93; 95% CI: 4·76- 5·11) was the main risk factor for subsequent LTFU, though for death, despite of advanced age (> 80 years-old) living with HIV (OR: 6·28; 95% CI: 6·03- 6·54) was the top risk factor.

Interpretation: Retreatment is a substantial factor driving increased risk of unfavourable TB outcomes, especially subsequent LTFU. The rates of treatment success in the retreatment group, especially in RLTFU, are distant from the WHO End TB Strategy targets throughout Brazil. By shedding light on the impact of prior LTFU on ATT outcomes, this study provides valuable insights for healthcare providers and policymakers.

Funding: Intramural Research program of the Oswaldo Cruz Foundation.

Declaration of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All other authors declare no competing interests.

Ethical Approval: All data analysed in this study were obtained from a public government program (SINANTB) and were pre-processed by the Brazilian Ministry of Health (https://datasus.saude.gov.br/informacoes-de-saude-tabnet/). The datasets were verified by eliminating duplicate registrations and ensuring consistency and completeness of registered data, following the regulations dictated by Resolution No. 466/12 on Research Ethics of the National Health Council, Brazil. Written informed consent for participation was not required for this study following national legislation and institutional requirements.

Keywords: Tuberculosis, loss to follow-up, Epidemiology, retreatment, treatment outcome

Suggested Citation

Barreto-Duarte, Beatriz and Villalva-Serra, Klauss and Miguez-Pinto, João P. and Araújo-Pereira, Mariana and Campos, Vanessa M. S. and Rosier, Gabriela and Nogueira, Betania M. F. and Queiroz, Artur T. L. and Rolla, Valeria C. and Cordeiro-Santos, Marcelo and Kritski, Afranio L. and Rebeiro, Peter F. and Sterling, Timothy R. and Rodrigues, Moreno M. S. and Andrade, Bruno B., Retreatment and Antituberculosis Therapy Outcomes in Brazil between 2015 and 2022: A Nationwide Study of Disease Registry Data. Available at SSRN: https://ssrn.com/abstract=4654261 or http://dx.doi.org/10.2139/ssrn.4654261

Beatriz Barreto-Duarte

Universidade Federal do Rio de Janeiro (UFRJ) ( email )

Athos da Silveira Ramos 149
Rio de Janeiro, 21941-909
Brazil

Klauss Villalva-Serra

Oswaldo Cruz Foundation (FIOCRUZ) - Gonçalo Moniz Institute (IGM) ( email )

João P. Miguez-Pinto

UNIFACS- Universidade Salvador ( email )

Mariana Araújo-Pereira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Vanessa M. S. Campos

UNIFACS- Universidade Salvador ( email )

Gabriela Rosier

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Betania M. F. Nogueira

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Salvador
Brazil

Artur T. L. Queiroz

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Salvador
Brazil

Valeria C. Rolla

Oswaldo Cruz Foundation (FIOCRUZ) - Evandro Chagas National Institute of Infectious Diseases (INI) ( email )

Av. Brasil 4365
Rio de Janeiro, 21040-360
Brazil

Marcelo Cordeiro-Santos

Universidade do Estado do Amazonas - Programa de Pós-Graduação em Medicina Tropical ( email )

Avenida Djalma Batista, 3578
Manaus, 69050-010
Brazil

Afranio L. Kritski

Universidade Federal do Rio de Janeiro (UFRJ) - Programa Acadêmico de Tuberculose ( email )

Rua Tonelero, 380 apt. 804
Copacabana, 22030-000
Brazil

Peter F. Rebeiro

Vanderbilt University - Division of Infectious Diseases ( email )

United States

Timothy R. Sterling

Vanderbilt University - Division of Infectious Diseases ( email )

United States

Moreno M. S. Rodrigues

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Análise e Visualização de Dados ( email )

Rio de Janeiro
Brazil

Bruno B. Andrade (Contact Author)

Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative ( email )

Oswaldo Cruz Foundation (FIOCRUZ) - Laboratório de Inflamação e Biomarcadores ( email )

Salvador
Brazil