Compreendendo as perdas na cascata de cuidados à infecção latente por tuberculose: um estudo de caso único

Abstract

Tuberculosis is an infectious and highly transmissible disease, responsible for 1.3 million deaths worldwide in recent years. It is caused by a bacterium that can lie dormant without causing symptoms for months or even decades. This condition is called Latent Tuberculosis Infection (LTBI). Correct management of LTBI is considered essential for TB control. This can be achieved through the LTBI care cascade, a method organized in stages that allows for its evaluation and improvement. This dissertation seeks to understand the reasons that lead to losses in all phases of the LTBI care cascade in contacts of patients with active TB followed by a national cohort study. The dissertation was conducted as a single case study, qualitative and descriptive, carried out at the Dr Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Amazonas, through three sources of evidence: documents, interviews, and direct observations. The collected data were organized and coded with the help of AtlasTi® software and analyzed through theoretical propositions. The results are presented through a case report, followed by a description of the results of the documentary analysis and the presentation of three categories created from the theoretical assumptions, namely: Participants' knowledge about LTBI; Reasons for losses in the LTBI care cascade; Contact investigation for TB control. The findings from the three sources of evidence show that losses in the LTBI care cascade occur due to contacts' lack of knowledge about LTBI, the low self-perceived risk of developing active TB due to the absence of symptoms, the use of other medications and work-related reasons. Investments are needed to avoid losses in the cascade, through the evaluation of the stages and the planning of public policies, paying special attention to the first stages of the cascade, since these are where the main losses occur.