challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

Funding Information: The study was supported by the São Paulo Research Foundation (FAPESP) [Grant 2018/14337–0], the National Council for Scientific and Technological Development (CNPq) [Grant 130160/2020–2] and Research Productivity Grant from the National Council for Scientific and Technological Development (CNPq) [Grant 304483/2018–4 - PQ modality (Level 1C)]. Publisher Copyright: © 2021, The Author(s).Background: Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control. Methods: We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study’s theoretical framework. Results: The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided. Conclusion: The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.publishersversionpublishe

Multidrug-resistant tuberculosis, its determinants, strategies for patient compliance and equity in the COVID-19 era: An analysis from the perspective of health professionals (Brazil, 2020)

Introdução: A tuberculose multidroga-resistente (TB-MDR) é um fenômeno grave em escala global, e muitos desafios são enfrentados no Brasil para a prevenção do surgimento de novos casos, e ainda garantir o sucesso de tratamento entre aqueles diagnosticados, e diante da pandemia da COVID-19 isso se tornou ainda mais complexo. Assim, o estudo objetivou compreender os determinantes da tuberculose multidroga-resistente segundo a percepção dos profissionais de saúde, que prestam cuidado direto a pacientes sob essa condição de saúde, e ainda os desafios e ou estratégias para adesão, considerando o contexto da pandemia da COVID-19 em município prioritário para o controle da doença no estado de São Paulo, Brasil. Métodos: Realizou-se um estudo qualitativo, com recrutamento intencional, de quatorze profissionais de saúde, sendo quatro médicos, três enfermeiras, três técnicos de enfermagem, três auxiliares de enfermagem e uma assistente social, que estavam na linha de frente no cuidado aos pacientes com TB-MDR. Aplicou-se entrevistas semiestruturadas remotas com esses profissionais, orientadas por roteiro estruturado. Para a análise dos dados, aplicou-se a análise de conteúdo modalidade temática, de acordo com referencial teórico dos determinantes sociais da saúde. Resultados: Os profissionais referem como principal causa da TB-MDR, a adquirida, devido à situação de pobreza, desigualdade e privação social. Em relação à pandemia COVID-19, os profissionais revelaram interferência no acompanhamento/ seguimento dos pacientes, o que pode prejudicar na sua conclusão do tratamento e transmissão comunitária. Verificou-se ainda, cortes nos auxílios e ou benefícios sociais que cobriam os pacientes, recursos importantes para a equidade em saúde e adesão ao tratamento. Os profissionais relataram preocupações quanto ao adoecimento das pessoas, também por COVID-19, e assim vêm adotando estratégias para que isso não ocorra, com reforço à estratégia DOTS. Conclusão: O estudo avança no conhecimento ao evidenciar os desafios enfrentados pelo sistema de saúde para a adesão de pacientes com TB-MDR em um contexto agravado pela pandemia. As estratégias definidas por esses profissionais de saúde têm garantido o alcance da equidade e evitado o encontro catastrófico entre TB-MDR e COVID-19.Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale, and many challenges are faced in Brazil to prevent the emergence of new cases, and to ensure the success of treatment among those diagnosed, and in the face of pandemic of COVID-19, this has become even more complex. Thus, the study aimed to understand the determinants of multidrug-resistant tuberculosis according to the perception of health professionals, who provide direct care to patients under this health condition, and also the challenges and / or strategies for adherence, considering the context of the COVID-19 pandemic in a priority municipality for disease control in the state of São Paulo, Brazil. Methods: A qualitative study was carried out, with intentional recruitment, of fourteen health professionals, four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker, who were at the forefront in patient care with TB-MDR. Remote semi-structured interviews were applied with these professionals, guided by a structured script. For data analysis, thematic modality content analysis was applied, according to the theoretical framework of the social determinants of health. Results: Professionals refer to acquired as the main cause of MDR-TB, due to the situation of poverty, inequality and social deprivation. In relation to the COVID-19 pandemic, the professionals revealed interference in the follow-up / follow-up of patients, which can impair their conclusion of treatment and community transmission. There were also cuts in aid and / or social benefits that covered patients, important resources for equity in health and adherence to treatment. The professionals reported concerns about people\'s illness, also due to COVID-19, and so they have been adopting strategies so that this does not happen, reinforcing the DOTS strategy. Conclusion: The study advances in knowledge by highlighting the challenges faced by the health system for the adherence of patients with MDR-TB in a context aggravated by the pandemic. The strategies defined by these health professionals have ensured the achievement of equity and avoided the catastrophic encounter between TB-MDR and COVID-19