Guy Harling|Antonio S. Lima Neto|Geziel S. Sousa|Márcia Maria Tavares Machado|Márcia C. Castro
Determinants of tuberculosis transmission and treatment abandonment in Fortaleza, Brazil
Harvard Global Health Institute|Universidade de Fortaleza|Universidade de Fortaleza|Universidade Federal do Ceará|Harvard Global Health Institute
tuberculosis tb remains public health problem despite recent achievements reducing incidence mortality rates brazil achievements worldwide average marked large regional heterogeneities fortaleza 5th largest city brazil tuberculosis cure rate declining treatment abandonment increasing past decade despite reduction incidence increase directly observed therapy dot trends put efforts eliminate tuberculosis risk therefore sought determine social programmatic determinants tuberculosis incidence treatment abandonment fortalezawe analyzed sociodemographic clinical data new tuberculosis cases notified notifiable diseases information system sinan fortaleza 2007 2014 calculated incidence rates 117 neighborhoods fortaleza assessed spatial clustering used spatial regression models quantify associations neighborhoodlevel covariates incidence rates used hierarchical logistic regression models evaluate individual neighborhoodlevel covariates predicted tuberculosis treatment abandonmentthere 12338 new cases reported study period case rates across neighborhoods significantly positively clustered two lowincome areas close city center adjusted model tuberculosis rates significantly higher neighborhoods lower literacy higher sewerage access homicide rates greater proportion selfreported black residents treatment abandoned 1901 cases 154 rate rose 71 2007 2014 abandonment significantly associated many individual sociodemographic clinical factors notably recommended dot protective completed dot associated abandonment notlow socioeconomic status areas higher tuberculosis rates low socioeconomic individuals higher risk treatment abandonment fortaleza treatment abandonment rates growing despite advent universal dot recommendations brazil proactive social policies active contact tracing find missed cases may help reduce tuberculosis burden setting