Abstract
To assess the degree of implementation of the Directly Observed Treatment, Short-course - DOTS for tuberculosis (TB) in a large city. Assessment of the implementation of the logic model, whose new cases of infectious pulmonary TB were recruited from specialized clinics and followed-up in basic health units. The judgment matrix covering the five components of the DOTS strategy were used. The result of the logic model indicates DOTS was partially implemented. In external, organizational and implementation contexts, the DOTS strategy was partially implemented; and, the effectiveness was not implemented. The partial implementation of the DOTS strategy in the city of Manaus did not reflect in TB control compliance, leading to low effectiveness of the program. Avaliar o grau de implantação da estratégia de tratamento diretamente observado (Directly Observed Treatment, Short-course - DOTS) para tuberculose (TB) em um município de grande porte. Avaliação de implantação por meio de modelo lógico, cujos casos novos de TB pulmonar bacilífera foram recrutados em ambulatórios especializados e acompanhados nas unidades básicas de saúde. Utilizou-se matriz de julgamento que abrange os cinco componentes da estratégia DOTS. O resultado do modelo lógico indica DOTS implantada parcialmente. Nos contextos externo, organizacional e de implantação, a estratégia DOTS está implantada parcialmente; e, na efetividade não está implantada. A implantação parcial da estratégia DOTS, na cidade de Manaus, reflete na não conformidade do controle da TB, levando à baixa efetividade do programa.
Highlights
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, but its determination is biological, and its control requires multiple strategies(1)
Implementation evaluation was performed through multiple case studies of 22 Basic Health Units (BHU) and four specialized clinics in the city of Manaus, with imbricated levels of analysis using the Matrix Analysis and Judgment based on the Evaluation Logic Model, adapted from a proposal for evaluation of the Program for Tuberculosis Control (PTC)(7)
In the implementation context (Table 3), we evaluated the implementation and coverage of the DOTS strategy, bacteriological diagnosis, supply of medicines and/or consumables and integrality
Summary
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, but its determination is biological, and its control requires multiple strategies(1). The disease is characterized by an insidious onset, whose treatment lasts at least six months, which is relatively long and difficult to achieve results through the control program, namely: an increase of cure rate (above 85%) and low percentage of treatment default (below 5%) (2). The recommendation is the decentralization of the program for primary care (PC) of the cities, as well as supervised treatment(2). In Brazil, in 2012, the average percentage of treatment default and cure were, respectively, 10.5% and 70.6%(3), the highest incidence rates are in the states of Rio de Janeiro and Amazonas. The Directly Observed Treatment, Short-course – DOTS, recommended by the World Health Organization (WHO), is based on five fundamental components: sustained political and financial commitment; diagnosis through quality ensured sputum-smear microscopy; standardized short-course anti-TB treatment given under direct and supportive observation (DOT); a management system for uninterrupted supply of anti-TB drugs; information system that allow monitoring and evaluation of actions and their impacts(4)
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