Determinants of multidrug‐resistant tuberculosis in São Paulo—Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services
Open Access
- 1 May 2020
- journal article
- research article
- Published by Wiley in Tropical Medicine & International Health
- Vol. 25 (7), 839-849
- https://doi.org/10.1111/tmi.13409
Abstract
Objective Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB. Methods Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian Spatial Hierarchical Analysis with a multilevel design was carried out. Results It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95%CI]:12.06‐15.93), positive sputum culture test (OR:5.26, 95%CI:4.44‐6.23), diabetes mellitus (OR:2.34, 95%CI:1.87‐2.91), residing at a standard address (OR:2.62, 95%CI:1.91‐3.60), positive sputum smear microscopy (OR:1.74, 95%CI:1.44‐2.12), cavitary pulmonary TB (OR:1.35, 95%CI:1.14‐1.60) and diagnosis performed due to spontaneous request (OR:1.26; 95%CI:1.10‐1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR:1.50, 95%CI:1.25‐1.79), that diagnosed TB cases only after death (OR:1.50, 95%CI:1.17‐1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR:1.56, 95%CI:1.30‐1.87) were also related to the MDR‐TB. Conclusions Knowledge of this predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.Funding Information
- Fundação de Amparo à Pesquisa do Estado de São Paulo (2017/2018, 11040‐4/14337‐0)
- Fundação de Amparo à Pesquisa do Estado de São Paulo
This publication has 31 references indexed in Scilit:
- Diagnostico da tuberculose: atencao basica ou pronto atendimento?Revista de Saúde Pública, 2013
- Meta-Analysis of Clinical Studies Supports the Pharmacokinetic Variability Hypothesis for Acquired Drug Resistance and Failure of Antituberculosis TherapyClinical Infectious Diseases, 2012
- Multidrug-Resistant Tuberculosis Not Due to Noncompliance but to Between-Patient Pharmacokinetic VariabilityThe Journal of Infectious Diseases, 2011
- The Social Determinants of Tuberculosis: From Evidence to ActionAmerican Journal of Public Health, 2011
- Tuberculosis control and elimination 2010–50: cure, care, and social developmentThe Lancet, 2010
- Approximate Bayesian Inference for Latent Gaussian models by using Integrated Nested Laplace ApproximationsJournal of the Royal Statistical Society Series B: Statistical Methodology, 2009
- Cavitary Pulmonary DiseaseClinical Microbiology Reviews, 2008
- Tuberculosis in London: the importance of homelessness, problem drug use and prisonThorax, 2007
- Drug-resistant tuberculosis: A disease of target populations in Houston, TexasJournal of Infection, 2006
- Interpreting Posterior Relative Risk Estimates in Disease-Mapping StudiesEnvironmental Health Perspectives, 2004