Publications (3)5.12 Total impact
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Article: Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study.
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ABSTRACT: Concomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV. We conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values. From a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome. The results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB.BMC Infectious Diseases 12/2011; 11:351. · 3.12 Impact Factor -
Article: Risk factors for treatment delay in pulmonary tuberculosis in Recife, Brazil.
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ABSTRACT: Tuberculosis is still a great challenge to public health in Brazil and worldwide. Early detection followed by effective therapy is extremely important in controlling the disease. Recent studies have investigated reasons for delays in treatment, but there is no agreed definition of what constitutes an "acceptable" delay. This study investigates factors associated with total delay in treatment of tuberculosis. A cohort of adult cases of pulmonary tuberculosis diagnosed over a two-year period was studied. Patients were interviewed on entry, reporting the duration of symptoms before the start of treatment, and sputum and blood samples were collected. It was decided that sixty days was an acceptable total delay. Associations were investigated using univariable and multivariable analysis and the population attributable fraction was estimated. Of 1105 patients, 62% had a delay of longer than 60 days. Age, sex, alcoholism and difficulty of access were not associated with delays, but associations were found in the case of unemployment, having given up smoking, having lost weight and being treated in two of the six health districts. The proportion attributable to: not being an ex-smoker was 31%; unemployment, 18%; weight loss, 12%, and going to the two worst health districts, 25%. In this urban area, delays seem to be related to unemployment and general attitudes towards health. Although they reflect the way health services are organized, delays are not associated with access to care.BMC Public Health 04/2005; 5:25. · 2.00 Impact Factor -
Article: Risk Factors for the Occurrence of Bancroftian Filariasis Infection in Children Living in Endemic Areas of Northeast of Brazil
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ABSTRACT: The objective of this study was to identity biological and social risk factors for the occurrence of microfilaraemia in a population of 1464 children of both sexes aged 5–14 years, living In two highly endemic areas of Recife a city in the northeast of Brazil. A survey was performed from December 1990 to July 1991 and the microfilaraemia was examined by the thick-drop technique using 45 μl of peripheral blood. Information was obtained about use of bednet, length of time living in area and number of occupants per household. Risk was quantified by the crude and adjusted Odds Ratio. The 95 per cent confidence interval, Likelihood Ratio Statistics, and P value were used to test the statistical significance. An association was established between microfilaraemia in children and adolescents, and age, number of individuals per household, the presence of microfilarnemic adults In the household, length of time living in the area, and bednet use. Maternal microfilaraemia was not found to be a risk factor for the occurrence of mlcrofilaraemla in offspring. These results allow the identification of children with a greater risk of microfilaraemia. In addition, these findings highlight the role of the household environment in the transmission process.
