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- Title
The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil.
- Authors
Terenciani Campoy, Laura; Henrique Arroyo, Luiz; Vieira Ramos, Antônio; Zamboni Berra, Thais; de Almeida Crispim, Juliane; Yamamura, Mellina; Carvalho Pinto, Ione; Aparecida Monroe, Aline; Rolim Scholze, Alessandro; de Paula Andrade, Rubia Laine; Alexander, Kamila Anise; Célia Fiorati, Regina; Lima de Freitas, Giselle; Alexandre Arcencio, Ricardo
- Abstract
Introduction: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. Methodology: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. Results: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. Conclusions: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.
- Subjects
SAO Paulo (Brazil); BRAZIL; TUBERCULOSIS; MIXED infections; MEDICAL care; SOCIAL services; AKAIKE information criterion
- Publication
Journal of Infection in Developing Countries, 2020, Vol 14, Issue 10, p1185
- ISSN
2036-6590
- Publication type
Article
- DOI
10.3855/jidc.12241