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

  • Bacterial Infections (H Bach, Section Editor)
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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.

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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

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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.

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  1. Pediatric Infectious Diseases, Santa Casa de São Paulo, Rua Dr. Cesário Mota Júnior 112, Vila Buarque, São Paulo, SP, 01221-020, Brazil

    Daniel Jarovsky MD

  2. Pediatric Infectious Diseases, Hospital Infantil Sabará, São Paulo, Brazil

    Daniel Jarovsky MD

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Jarovsky, D. Treatment of Tuberculosis in Brazil—Past, Present, and Future Challenges. Curr Treat Options Infect Dis 11, 58–72 (2019). https://doi.org/10.1007/s40506-019-0182-3

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