Tuberculosis control in a socially vulnerable area: a community intervention beyond DOT in a Brazilian favela
DESIGN: In July 2003, 40 lay persons were hired and trained as community health workers to supervise treatment, implement educational activities and establish a supportive social network for anti-tuberculosis treatment. Between July 2005 and June 2008, a door-to-door active case finding campaign was conducted. Data were obtained from the Brazilian National Reporting System, which collects information from the TB notification form for every reported case.
RESULTS: Between January 2001 and December 2008, 2623 TB cases were reported, 852 before and 1771 after the start of the program. Following the intervention, treatment success rates increased (67.6% vs. 83.2%, P < 0.001) and default rates dropped (17.8% vs. 5.5%, P < 0.001). Compared to the pre-intervention period, the TB case rate declined by an average of 39 cases per 100 000 population per 6 months (P = 0.003) in the post-intervention period, although this may have been due to secular trends already in place at the start of the intervention. Case rates declined from 591/100 000 in 2001 to 496/100 000 in 2008.
CONCLUSION: With proper planning and effective community involvement, a successful intervention can lead to high cure rates and may contribute to a decrease in TB notification rates.
Document Type: Research Article
Affiliations: 1: City of Rio de Janeiro Health Secretariat, Rio de Janeiro, Rio de Janeiro, Brazil 2: Kaiser Permanente Center for Health Research, Portland, OR, USA 3: City of Rio de Janeiro Health Secretariat, Rio de Janeiro, Rio de Janeiro, Brazil; IPEC-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil 4: IPEC-Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil 5: Johns Hopkins University, Center for Tuberculosis Research, Baltimore, MD, USA
Publication date: December 1, 2013
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