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Treatment of Tuberculosis in Brazil—Past, Present, and Future Challenges

  • Daniel JarovskyEmail author
Bacterial Infections (H Bach, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Bacterial Infections

Abstract

Purpose of review

Almost 75 years since the introduction of chemotherapy for the treatment of tuberculosis (TB), it remains the single leading infectious cause of mortality and one of the top 10 causes of deaths in 2016 worldwide. Brazil is one of the countries with the highest burden of disease in the world, and despite the downward trend in disease incidence and mortality, TB is still the third leading cause of death among infectious diseases in the country. Although diagnosis and treatment are performed universally and free of charge, barriers in access result in 69,500 new cases and 4500 deaths each year. This review provides a historical overview and the latest knowledge of TB treatment and adherence optimization in Brazil.

Recent findings

Chemotherapy remains the main component of the arsenal used to control TB. The currently available treatments can cure almost all TB cases with a timely diagnosis; however, failing to complete prescribed therapy can lead to poor outcomes, including increased risk of treatment failure, disease relapse, sustained transmission, development of drug resistance, and ultimately death. Adherence is a complex and challenging key element for treatment success. Thus, several intervention strategies to improve compliance have been used during the last several decades of TB treatment. Among the most used and recommended by the World Health Organization, fixed dose combinations and directly observed therapy are discussed in detail.

Summary

New drugs and shorter regimens may constitute the main treatment for drug-sensitive and MDR-TB in the future. Increasing access to rapid automated nucleic acid amplification tests and culture of sputum are key elements for diagnosis and management of MDR-TB. Treatment descentralization, the incorporation of directly observed therapy to the Family Health Strategy, fixed dose combinations, and non-financial incentives are among options used by the Brazilian Ministry of Health for improving compliance.

Keywords

Tuberculosis Mycobacterium tuberculosis History of tuberculosis Directly observed therapy Fixed dose combination treatment 

Abbreviations

PLHIV/AIDS

People living with human immunodeficiency virus or acquired immunodeficiency syndrome

DOT

directly observed treatment

FDC

Fixed dose combination

LTBI

latent tuberculosis infection

MDR-TB

multidrug-resistant tuberculosis

MoH

Ministry of Health

REDE-TB

Rede Brasileira de Pesquisas em Tuberculose

SMS

short message service

SUS

Brazilian Unified National Health System

TB

Tuberculosis

VOT

video/virtually-observed therapy

XDR-TB

extensively drug-resistant tuberculosis

WHO

World Health Organization

Notes

Acknowledgments

I would like to show my gratitude to Maria Josefa “Pepita” Penon Rujula Gonçalves (Faculdade de Ciências Médicas da Santa Casa de São Paulo; Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”) for sharing pearls of wisdom during this research. I also thank Sidney Bombarda (Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac”) for comments that greatly improved the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The author declares that he has no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Authors and Affiliations

  1. 1.Pediatric Infectious DiseasesSanta Casa de São PauloSão PauloBrazil
  2. 2.Pediatric Infectious DiseasesHospital Infantil SabaráSão PauloBrazil

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