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Tuberculosis control in a highly endemic indigenous community in Brazil

机译：巴西高度流行的土著社区的结核病控制

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摘要

In Latin America, indigenous populations have high rates of non-completion of TB treatment and case fatality and have been defined as a priority group for investments. To evaluate TB control, a retrospective cohort study was performed to identify factors predictive of non-completion of treatment and mortality in an indigenous and non-indigenous population between 2002 and 2008 in Dourados, Brazil. A 90% reduction in non-completion of TB treatment was observed in the indigenous population after DOTS (directly observed treatment, short course) implementation (20% vs 2%). In the non-indigenous population, the number of patients not completing TB treatment continued to increase. Non-indigenous TB patients had 4.5 times higher mortality than indigenous TB patients (9% vs 2%). In multivariate analysis, non-indigenous race [odds ratio (OR) 2.33, 95% CI 1.32-4.10] was associated with non-completion of TB treatment, and HIV-positive status (OR 5.58, 95% CI 2.38-13.07) was associated with mortality. Implementation of DOTS in the indigenous populations in Dourados showed a significant reduction in non-completion of TB treatment. Nevertheless, a high rate of TB in children and young adults indicates the continuous transmission and maintenance of the epidemic in this community. Among the non-indigenous population, the TB case fatality rate is closely linked to the HIV prevalence.
机译：在拉丁美洲，土著人民的结核病治疗未完成率高，病死率高，被定义为投资的优先群体。为了评估结核病的控制，进行了一项回顾性队列研究，以鉴定预测2002年至2008年巴西杜拉多斯市土著和非土著人口治疗未完成和死亡率的因素。实施DOTS（直接观察到的治疗，短期治疗）后，土著人群的未完成结核病治疗减少了90％（20％比2％）。在非土著人群中，未完成结核病治疗的患者人数继续增加。非土著结核病患者的死亡率是土著结核病患者的4.5倍（9％对2％）。在多变量分析中，非土著种族[比值比（OR）2.33，95％CI 1.32-4.10]与未完成结核病治疗相关，HIV阳性（OR 5.58，95％CI 2.38-13.07）与死亡率有关。在Dourados的土著居民中实施DOTS表明，结核病未完成治疗的人数大大减少。然而，儿童和年轻人中结核病的高发病率表明该社区的流行病持续传播和维持。在非土著人口中，结核病的死亡率与艾滋病毒的流行密切相关。

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