Drug-resistant tuberculosis: integrative review of nursing care in primary health care

Germano, Sibele Naiara Ferreira; Erdmann, Alacoque Lorenzini; Albuquerque, Camila Freire; Amante, Lúcia Nazareth; Ferreira, Darlisom Sousa; Garrido, Marlucia da Silva

doi:10.1590/0034-7167-2023-0097

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 77 (2) • 2024 • https://doi.org/10.1590/0034-7167-2023-0097 copy

Drug-resistant tuberculosis: integrative review of nursing care in primary health care

Tuberculosis farmacorresistente: revisión integradora de los cuidados de enfermería en la atención primaria de salud

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to identify, in the scientific literature, the care that should be provided to individuals with drug-resistant tuberculosis by nurses in primary health care.

Methods:

integrative review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses study selection flowchart. Data collection was conducted in November 2022, across ten databases.

Results:

six studies emphasized that nurses should perform directly observed treatment; two highlighted the importance of integrated care management between tuberculosis and human immunodeficiency virus; two demonstrated comprehensive nursing consultation using the nursing process; one emphasized person-centered care, with discharge planning and improved hospital communication with primary health care services.

Final Considerations:

the care that nurses should provide to individuals with drug-resistant tuberculosis in primary health care, for care resolution, is evidence-based.

Descriptors
Tuberculosis; Tuberculosis, Multidrug-Resistant; Nurses; Nursing Care; Primary Health Care

Database	Search Strategies
Cumulative Index to Nursing and Allied Health Literature National Library of Medicine/ Medical Literature Analysis and Retrieval System Online Excerpta Medical Database Cochrane Library Scopus Web of Science	(Tuberculosis OR “Koch Disease” OR “Koch’s Disease” OR “Kochs Disease” OR “Mycobacterium tuberculosis Infection” OR “Mycobacterium tuberculosis Infections” OR Tuberculoses OR “Tuberculosis, Multidrug-Resistant” OR “Drug-Resistant Tuberculosis” OR “MDR Tuberculosis” OR “Multi-Drug Resistant Tuberculosis” OR “Multidrug-Resistant Tuberculosis” OR “Tuberculosis, Drug Resistant”) AND (Nurses OR Nurse OR “Nursing Personnel” OR “Registered Nurse” OR “Registered Nurses” OR “Nursing Care” OR “Nursing Care Management”) AND (“Primary Health Care” OR “Health Care, Primary” OR “Primary Care” OR “Primary Healthcare”)
Literatura Latino-Americana de Ciências da Saúde Banco de Dados em Enfermagem	(Tuberculose OR Tb OR “Infecção por Mycobacterium tuberculosis” OR “Pneumologia Sanitária” OR Tb OR Tuberculosis OR “Infección por Mycobacterium tuberculosis”) AND (“Enfermeiras e Enfermeiros” OR Enfermeira OR “Enfermeira e Enfermeiro” OR “Enfermeira Registrada” OR Enfermeiras OR “Enfermeiras Registradas” OR “Enfermeiro e Enfermeira” OR “Enfermeiro Registrado” OR “Enfermeiros e Enfermeiras” OR “Enfermeiros Registrados” OR “Enfermeras y Enfermeros” OR Enfermera OR “Enfermera Registrada” OR “Enfermera y Enfermero” OR Enfermeras OR “Enfermeras Registradas” OR “Enfermero Registrado” OR “Enfermero y Enfermera” OR “Enfermeros Registrados” OR “Enfermeros y Enfermeras” OR “Cuidados de Enfermagem” OR “Assistência de Enfermagem” OR “Atendimento de Enfermagem” OR “Cuidado de Enfermagem” OR “Gestão da Assistência de Enfermagem” OR “Sistematização da Assistência de Enfermagem” OR “Atención de Enfermería” OR “Cuidado de Enfermería” OR “Cuidados de Enfermería”)
Scientific Electronic Library Online	(“Tuberculose Resistente a Múltiplos Medicamentos” OR “Tuberculosis Resistente a Múltiples Medicamentos”) AND (Enfermeiros OR Enfermeros OR “Cuidados de enfermagem” OR “Atención de Enfermería” OR Enfermagem)

Study Title Methodological	Year Country	Design	Main Results/Conclusions of Nursing Care	Level of Evidence GRADE
An intervention to optimise the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomised trial(¹⁸18 Kufa T, Fielding KL, Hippner P, Kielmann K, Vassal A, Churchyard GJ, et al. An intervention to optimize the delivery of integrated tuberculosis and HIV services at primary care clinics: results of the MERGE cluster randomized trial. Contemp Clin Trials. 2018;72:43-52. https://doi.org/10.1016/j.cct.2018.07.013 https://doi.org/10.1016/j.cct.2018.07.01... )	2018 South Africa	Randomized cluster trial	Integrated care management for TB/HIV with early diagnosis and guideline-based treatment, including contact tracing.	High
Nurses’ Knowledge of Tuberculosis, HIV, and Integrated HIV/TB Care Policies in Rural Western Cape, South Africa(¹⁹19 Phetlhu DR, Bimerew M, Marie-Modeste RR, Mogasweri MA, Igumbor J. Nurses’ Knowledge of Tuberculosis, HIV, and Integrated HIV/TB Care Policies in Rural Western Cape, South Africa. J Assoc Nurses AIDS Care. 2018;29(6):876-86. https://doi.org/10.1016/j.jana.2018.05.008 https://doi.org/10.1016/j.jana.2018.05.0... )	2018 South Africa	Qualitative and quantitative	Integrated TB/HIV care management following extensive training of professionals in TB guidelines and its severe form, DR-TB.	High
Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff(²⁰20 Marais F, Kallon II, Dudley LD. Continuity of care for TB patients at a South African hospital: a qualitative participatory study of the experiences of hospital staff. PLoS ONE. 2019;14(9):e0222421. https://doi.org/10.1371/journal.pone.0222421 https://doi.org/10.1371/journal.pone.022... )	2019 South Africa	Action research	Person-centered care, with discharge planning and improved hospital communication with PHC services.	Low
Percepções de enfermeiros sobre gestão do cuidado e seus fatores intervenientes para o controle da tuberculose(²¹21 Silva FO, Rodrigues ILA, Pereira AA, Nogueira LMV, Andrade EGR, Araújo APGM. Percepções de enfermeiros sobre gestão do cuidado e seus fatores intervenientes para o controle da tuberculose. Esc Anna Nery. 2022;26:e20210109. https://doi.org/10.1590/2177-9465-EAN-2021-0109 https://doi.org/10.1590/2177-9465-EAN-20... )	2022 Brazil	Qualitative	Nursing consultation, monitoring of confirmed cases with control bacilloscopy; Directly Observed Treatment (DOT); treatment of Latent Tuberculosis Infection (LTBI); and health education.	Moderate
Consulta de enfermagem a pessoas com TB: proposta de instrumento(²²22 Vale DL, Freire VECS, Pereira LFB. Consulta de enfermagem a pessoas com tuberculose: proposta de instrumento. Ciênc Cuid Saúde. 2020;19:e50102. https://doi.org/10.4025/cienccuidsaude.v19i0.50102 https://doi.org/10.4025/cienccuidsaude.v... )	2020 Brazil	Action research	Nursing consultation for individuals with TB and DR-TB using the Nursing Process, encompassing all stages, promoting individualized and appropriate care for each person.	Moderate
Representations on adherence to the treatment of Multidrug-Resistant Tuberculosis(²³23 Ferreira KR, Orlandi GM, Silva TC, Bertolozzi MR, França FOS, Bender A. Representations on adherence to the treatment of Multidrug-Resistant Tuberculosis. Rev Esc Enferm USP. 2018;52:e03412. https://doi.org/10.1590/S1980-220X2018010303412 https://doi.org/10.1590/S1980-220X201801... )	2018 Brazil	Qualitative	Welcoming, attentive listening, clarification of doubts, and establishing rapport. Implementation of DOT to ensure treatment adherence and monitor medication side effects; providing health education to patients and their families.	Low
Coordination and list of services for the management of tuberculosis: perspective of health professionals(²⁴24 Ferreira MRL, Bonfim RO, Siqueira TC, Orfão NH. Coordination and list of services for the management of tuberculosis: perspective of health professionals. Physis. 2022;32(1). https://doi.org/10.1590/S0103-73312022320111 https://doi.org/10.1590/S0103-7331202232... )	2022 Brazil	Quantitative	DOT, including home visits for monthly monitoring and supervision of patients and their contacts; conducting rapid HIV testing for all TB patients; ensuring smooth referral and counter-referral processes with TB, DR-TB, and HIV reference services.	Low
Nurses’ discourses on actions and strategies of care for the elderly with tuberculosis(²⁵25 Araújo EMNF, Freitas SA, Henriques AHB, Nogueira MF, Barrêto AJR. Nurses’ discourses on actions and strategies of care for the elderly with tuberculosis. Rev Baiana Enferm. 2022;36:e45266. https://doi.org/10.18471/rbe.v36.45266 https://doi.org/10.18471/rbe.v36.45266... )	2022 Brazil	Qualitative	Comprehensive care encompasses active case finding, incentives, home visits, health education, and examinations.	Very Low
Percepção de enfermeiros: enfoque na família e orientação para a comunidade nas ações de TB(²⁶26 Siqueira TC, Martellet MG, Tavernard GLN, Silva VM, Moura STS, Silva LAF, et al. Percepção de enfermeiros: enfoque na família e orientação para a comunidade nas ações de tuberculose. Ciênc Cuid Saúde. 2020;19:e50175. https://doi.org/10.4025/cienccuidsaude.v19i0.50175 https://doi.org/10.4025/cienccuidsaude.v... )	2020 Brazil	Quantitative	Engagement of TB patients in care plan development and planning process, while respecting and fostering autonomy in carrying out DOT, strengthening relationships, implementing promotional and preventive measures, screening for respiratory symptoms, and providing health education.	Very Low
Passos e descompassos no processo de cuidado aos portadores de tuberculose na atenção primária(²⁷27 Melo LSO, Oliveira EN, Ximenes Neto FRG, Viana LS, Prado FA, Costa JBC. Passos e descompassos no processo de cuidado aos portadores de tuberculose na atenção primária. Enferm Foco. 2020;11(1):136-41. https://doi.org/10.21675/2357-707X.2020.v11.n2.2917 https://doi.org/10.21675/2357-707X.2020.... )	2020 Brazil	Qualitative	Care delivery aligned with the policies and strategies of the World Health Organization: early diagnosis through active case finding, HIV testing, DOT, and ongoing education to promote evidence-based practice.	Low
Provider perspectives of the introduction and implementation of care for drug-resistant tuberculosis patients in districtlevel facilities in South Africa: a qualitative study(²⁸28 Vanleeuw L, Atkins S, Zembe-Mkabile W, Loveday M. Provider perspectives of the introduction and implementation of care for drug-resistant tuberculosis patients in district level facilities in South Africa: a qualitative study. BMJ Open. 2020;10(2):e032591. https://doi.org/10.1136/bmjopen-2019-032591 https://doi.org/10.1136/bmjopen-2019-032... )	2020 South Africa	Qualitative	Decentralized care involving DOT, monitoring of side effects, and adherence through monthly sputum collection and routine testing.	Moderate

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[1] Corresponding author: Sibele Naiara Ferreira Germano, E-mail: sibelenaiaraferreiragermano@gmail.com