
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Retreatment and Antituberculosis Therapy Outcomes in Brazil between 2015 and 2022: A Nationwide Study of Disease Registry Data
25 Pages Posted: 7 Dec 2023
More...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: Suggested Citation