Partial recovery of tuberculosis preventive treatment in Brazil after pandemic drawback

Coutinho, Iane; Alves, Layana Costa; Werneck, Guilherme Loureiro; Trajman, Anete

doi:10.1590/0102-311XEN192923

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ARTICLE • Cad. Saúde Pública 40 (5) • 2024 • https://doi.org/10.1590/0102-311XEN192923 copy

Partial recovery of tuberculosis preventive treatment in Brazil after pandemic drawback

Recuperação parcial do tratamento preventivo da tuberculose no Brasil após o recuo pandêmico

Recuperación parcial del tratamiento preventivo de la tuberculosis en Brasil tras el retroceso pandémico

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Brazil was heavily affected by COVID-19 both with death toll and economically, with absence of a centralized Federal Government response. Tuberculosis (TB) notifications decreased in 2020 but partial recovery was observed in 2021. We have previously shown a sharp (93%) reduction in TB preventive treatment notifications among five Brazilian cities with more than 1,000 notifications in 2021. We hypothesized TB preventive treatment would also recover. We updated the previous analysis by adding other cities that hold more than a 1,000 notifications until 2022. Data aggregated by 2-week periods were extracted from the Information System for Notifying People Undergoing Treatment for LTBI (IL-TB). Biweekly percentage change (BPC) of notifications until October 2022 and outcomes until July 2022 (in the two weeks of TB preventive treatment initiation) were analyzed using Joinpoint software. A total of 39,701 notifications in 11 cities were included, 66% from São Paulo and Rio de Janeiro, Brazil. We found a significant increase of TB preventive treatment notifications in the beginning of 2021 (BPC range 1.4-49.6), with sustained progression in seven out of the 11 cities. Overall, median completion rates were 65%. In most cities, a gradual and steady decrease of treatment completion rates was found, except for Rio de Janeiro and Manaus (Amazonas State, Brazil), where a BPC of 1.5 and 1.2, respectively, was followed by a sustained increase. Notifications and completion proportions of TB preventive treatment were heterogeneous, which partly reflects the heterogeneity in local response to the pandemic. We found that notifications were recovered, and that the sharp 2021 decrease was no longer observed, which suggests delays in notification. In conclusion, the sharp reductions in TB preventive treatment completion rates in most cities might have been caused by delays in reporting; however, the sustained and progressive decrease are a concern.

Keywords:
SARS-CoV-2; Coronavirus; Tuberculosis; Isoniazid; Rifampin

EW (year)	BPC	95%CI	Prob > \|t\|
São Paulo
Notified TB preventive treatment
47 (2018) to 5 (2019)	46.4 *	26.7; 69.2	< 0.001
5 (2019) to 41 (2019)	4.5 *	2.1; 6.9	< 0.001
41 (2019) to 15 (2020)	-3.6	-7.3; 0.1	0.057
15 (2020) to 29 (2021)	1.4 *	0.6; 2.3	0.001
29 (2021) to 40 (2022)	1.8 *	0.7; 2.9	0.002
Proportion of outcomes
1 (2019) to 41 (2021)	-0.3 *	-0.4; -0.2	< 0.001
41 (2021) to 1 (2022)	3.0	-1.9; 8.2	0.229
1 to 30 (2022)	-1.4 *	-2.4; -0.4	0.008
Rio de Janeiro
Notified TB preventive treatment
41 (2018) to 11 (2020)	1.7 *	1.3; 2.1	< 0.001
11 (2020) to 40 (2022)	1.8 *	1.0; 2.7	< 0.001
Proportion of outcomes
1 (2019) to 23 (2021)	-0.5 *	-0.7; -0.3	< 0.001
23 (2021) to 30 (2022)	1.5 *	0.9; 2.1	< 0.001
Recife
Notified TB preventive treatment
17 (2019) to 9 (2020)	-0.5	-2.6; 1.7	0.668
9 (2020) to 17 (2020)	-27.1	-53.5; 14.2	0.163
17 (2020) to 31 (2021)	4.6 *	3.3; 5.9	< 0.001
31 (2021) to 40 (2022)	-0.7	-2.4; 1.1	0.450
Proportion of outcomes
17 (2019) to 19 (2022)	-1.0 *	-1.7; -0.2	0.015
19 to 30 (2022)	-53.4 *	-71.5; -23.6	0.003
Manaus
Notified TB preventive treatment
39 (2019) to 19 (2020)	-8.2 *	-11.8; -4.5	< 0.001
19 (2020) to 47 (2020)	6.2 *	0.6; 12.2	0.032
47 (2020) to 1 (2021)	-44.6	-80.6; 57.6	0.257
1 (2021) to 13 (2021)	49.6 *	18.4; 89.0	0.001
13 (2021) to 40 (2022)	1.9 *	1.0; 2.9	< 0.001
Proportion of outcomes
39 (2019) to 19 (2022)	-0.1	-0.2; 0.1	0.605
19 to 30 (2022)	1.2 *	0.2; 2.1	0.015
Fortaleza
Notified TB preventive treatment
29 (2019) to 7 (2020)	-0.2	-4.4; 4.1	0.907
7 to 19 (2020)	-20.1	-36.2; 0.1	0.051
19 to 33 (2020)	16.3	-1.9; 37.9	0.080
33 (2020) to 3 (2022)	-0.7	-2.2; 0.8	0.342
3 to 40 (2022)	4.0 *	1.4; 6.7	0.004
Proportion of outcomes
29 (2019) to 30 (2022)	-1.0 *	-1.8; -0.2	0.017
Porto Alegre
Notified TB preventive treatment
41 (2019) to 5 (2020)	29.5 *	10.9; 51.2	0.002
5 (2020) to 3 (2022)	0.2	-0.8; 1.2	0.675
3 (2022) to 40 (2022)	1.8	-1.7; 5.3	0.297
Proportion of outcomes
35 (2019) to 30 (2022)	-0.1	-0.3; 0.2	0.721
São Luís
Notified TB preventive treatment
1 to 9 (2020)	10.4	-28.4; 70.0	0.647
9 to 15 (2020)	-58.8	-89.5; 61.7	0.198
15 to 31 (2020)	32.1 *	10.1; 58.6	0.004
31 (2020) to 47 (2021)	0.1	-1.5; 1.8	0.878
47 (2021) to 40 (2022)	0.9	-1.8; 3.8	0.489
Proportion of outcomes
1 (2020) to 30 (2022)	-0.2	-0.4; 0.0	0.068
Salvador
Notified TB preventive treatment
43 (2019) to 15 (2020)	-1.3	-8.0; 5.9	0.711
15 to 21 (2020)	-45.5	-83.4; 78.7	0.311
21 (2020) to 29 (2020)	65.3	-8.7; 199.5	0.095
29 (2020) to 23 (2022)	0.5	-0.4; 1.3	0.287
23 to 31 (2022)	7.2 *	6.7; 7.7	< 0.001
31 to 40 (2022)	5.7 *	5.4; 6.0	< 0.001
Proportion of outcomes
1 (2019) to 30 (2022)	-0.1	-0.7; 0.4	0.69
Belém
Notified TB preventive treatment
1 to 11 (2019)	34.3	-1.0; 82.1	0.058
11 (2019) to 11 (2020)	-1.3	-3.9; 1.3	0.314
11 (2020) to 21 (2020)	-28.5	-53.5; 10.1	0.124
21 (2020) to 49 (2020)	17.0 *	9.0; 25.7	< 0.001
49 (2020) to 33 (2022)	2.6 *	1.6; 3.6	< 0.001
Proportion of outcomes
1 (2019) to 49 (2021)	-0.7	-1.3; 0.0	0.062
49 (2021) to 30 (2022)	-24.1 *	-29.3; -18.4	< 0.001
Curitiba
Notified TB preventive treatment
37 (2019) to 25 (2020)	-10.5 *	-14.5; -6.3	< 0.001
25 (2020) to 32 (2021)	3.5 *	0.9; 6.3	0.010
32 (2021) to 40 (2022)	2.7*	0.7; 4.8	0.010
Proportion of outcomes
35 (2019) to 30 (2022)	-0.8	-1.8; 0.3	0.145
Campinas
Notified TB preventive treatment
1 to 19 (2019)	30.7 *	9.9; 55.4	0.003
19 (2019) to 49 (2020)	-2.2 *	-3.9; -0.4	0.020
49 (2020) to 40 (2022)	1.9 *	1.1; 2.8	< 0.001
Proportion of outcomes
1 (2019) to 19 (2022)	-0.1	-0.4; 0.1	0.283
19 to 25 (2022)	-77.2 *	-89.8; -49.0	< 0.001
25 to 30 (2022)	12.7	-49.7; 152.1	0.769

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[1] Correspondence
I. Coutinho Rua Ubaldino do Amaral 40, apto. 912, Rio de Janeiro, RJ 20231-016, Brasil. iane.coutinho@hotmail.com