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Objective: The objective of this study is to evaluate the performance of the Tuberculosis Control Program in municipalities of the State of São Paulo., Methods: This is a program evaluation research, with ecological design, which uses three non-hierarchical groups of the municipalities of the State of São Paulo according to their performance in relation to operational indicators. We have selected 195 municipalities with at least five new cases of tuberculosis notified in the Notification System of the State of São Paulo and with 20,000 inhabitants or more in 2010. The multiple correspondence analysis was used to identify the association between the groups of different performances, the epidemiological and demographic characteristics, and the characteristics of the health systems of the municipalities., Results: The group with the worst performance showed the highest rates of abandonment (average [avg] = 10.4, standard deviation [sd] = 9.4) and the lowest rates of supervision of Directly Observed Treatment (avg = 6.1, sd = 12.9), and it was associated with low incidence of tuberculosis, high tuberculosis and HIV, small population, high coverage of the Family Health Strategy/Program of Community Health Agents, and being located on the countryside. The group with the best performance presented the highest cure rate (avg = 83.7, sd = 10.5) and the highest rate of cases in Directly Observed Treatment (avg = 83.0, sd = 12.7); the group of regular performance showed regular results for outcome (avg cure = 79.8, sd = 13.2; abandonment avg = 9.5, sd = 8.3) and supervision of the Directly Observed Treatment (avg = 42.8, sd = 18.8). Large population, low coverage of the Family Health Strategy/Program of Community Health Agents, high incidence of tuberculosis and AIDS, and being located on the coast and in metropolitan areas were associated with these groups., Conclusions: The findings highlight the importance of the Directly Observed Treatment in relation to the outcome for treatment and raise reflections on the structural and managerial capacity of municipalities in the implementation of the Tuberculosis Control Program., Objetivo: Avaliar o desempenho do Programa de Controle da Tuberculose em municípios paulistas., Métodos: Pesquisa de avaliação de serviços, com delineamento ecológico, utilizando três agrupamentos não hierárquicos de municípios paulistas de acordo com seu desempenho em relação a indicadores operacionais. Foram selecionadas 195 cidades com no mínimo cinco casos novos de tuberculose notificados no Sistema de Notificação do Estado de São Paulo e 20.000 habitantes ou mais em 2010. A análise de correspondência múltipla foi utilizada para a identificação da associação entre os grupos de distintos desempenhos e as características epidemiológicas, demográficas e de sistemas de saúde dos municípios., Resultados: O grupo de pior desempenho apresentou as taxas mais elevadas de abandono (média [md] = 10,4; desvio padrão [dp] = 9,4) e as menores proporções de efetivação de Tratamento Diretamente Observado (md = 6,1; dp = 12,9) e esteve associado à baixa incidência de tuberculose, alta confecção tuberculose e HIV, pequeno porte populacional, alta cobertura de Estratégia Saúde da Família/Programa de Agentes Comunitários em Saúde e localização no interior. O grupo de melhor desempenho apresentou a maior taxa de cura (md = 83,7; dp = 10,5) e a maior proporção de casos em Tratamento Diretamente Observado (md = 83,0; dp = 12,7); enquanto o grupo de desempenho regular mostrou resultados regulares de desfecho (cura: md = 79,8; dp = 13,2; abandono: md = 9,5; dp = 8,3) e de efetivação do Tratamento Diretamente Observado (md = 42,8; dp = 18,8). Grande porte populacional, baixa cobertura de Estratégia Saúde da Família/Programa de Agentes Comunitários em Saúde, alta incidência de tuberculose e aids, e localização no litoral e em áreas metropolitanas estiveram associados com esses grupos., Conclusões: Os achados destacam a importância do Tratamento Diretamente Observado em relação ao desfecho do tratamento e levantam reflexões sobre a capacidade estrutural e gerencial dos municípios na operacionalização do Programa de Controle da Tuberculose.

Objective: to analyze the offering of health actions and services for the control of tuberculosis for people living with HIV/AIDS being followed up in the Specialized Care Services for HIV/AIDS in Ribeirão Preto, SP, Brazil., Method: quantitative, exploratory survey study. Participated 253 people living with HIV/AIDS followed up by this service, considering as inclusion criteria: individuals older than 18 years living in the city and not inmates. Data collection was conducted from January 2012 to May 2013 through interviews with the support of a specific instrument. Data were analyzed using indicators and a composite index., Results: the offering of services for the control of tuberculosis in people living with HIV/AIDS by municipal services was considered as intermediate, reinforcing the need for better planning for comprehensive assistance, coordination of professionals in teams and among the services network, in addition to professional training and continuing education., Conclusion: it is necessary to implement strategies that promote shared actions between TB and HIV / AIDS programs and between different services in order to strengthen the local care network, aimed at producing an individualized care, comprehensive and responsive., Objetivo: analisar a oferta das ações e serviços de saúde para o controle da tuberculose nas pessoas vivendo com HIV/aids em seguimento pelos Serviços de Atenção Especializada ao HIV/aids de Ribeirão Preto, SP, Brasil., Método: estudo quantitativo, exploratório, do tipo inquérito. Participaram 253 pessoas vivendo com HIV/aids em seguimento nos serviços, considerando os critérios de inclusão: indivíduos maiores de 18 anos, residentes no município e não pertencentes ao sistema prisional. A coleta de dados foi realizada no período de janeiro/2012 a maio/2013, por meio de entrevistas com apoio de um instrumento específico. Os dados foram analisados mediante indicadores e índice composto., Resultados: a oferta de ações e serviços para o controle da tuberculose nas pessoas vivendo com HIV/aids pelos serviços do município foi considerada regular, reforçando a necessidade de melhor planejamento da assistência de forma integral, articulação dos profissionais nas equipes e entre os serviços da rede, além da formação profissional e educação permanente., Conclusão: faz-se necessário a implementação de estratégias que favoreçam ações compartilhadas entre os programas de tuberculose e HIV/aids e entre os diferentes serviços, com o intuito de fortalecer a rede local de atenção objetivando a produção de um cuidado singular, integral e resolutivo., Objetivo: analizar la oferta de acciones y servicios de salud para el control de la tuberculosis en las personas viviendo con VIH-SIDA acompañadas por los Servicios de Atención Especializada al VIH-SIDA de Ribeirao Preto, SP, Brasil., Método: estudio cuantitativo, exploratorio, de tipo encuesta. Participaron 253 personas viviendo con VIH-SIDA seguidas por estos servicios, considerando como criterios de inclusión: individuos mayores de 18 años, residentes en el municipio y no ser del sistema de prisiones. La recolección de datos fue realizada en el periodo de enero de 2012 a mayo de 2013, por medio de entrevistas guiadas por un instrumento especifico. Los datos fueron analizados mediante indicadores y un índice compuesto., Resultados: la oferta de acciones y servicios para el control de la tuberculosis en personas viviendo con VIH-SIDA fue considerada intermedia, reforzando la necesidad de mejorar la planificación de la asistencia en forma integral, la articulación de los profesionales en los equipos y entre los servicios de la red, además de la formación profesional y la educación permanente., Conclusión: se hace necesaria la implementación de estrategias que favorezcan las acciones compartidas entre los programas de tuberculosis y VIH-SIDA y entre los diferentes servicios, con el fin de fortalecer la red local de atención para producir un cuidado personalizado, integral y resolutivo.

Background: Diagnosis and treatment of latent tuberculosis infection (LTBI) is a tool for global TB control, especially in close contacts. But data is scarce in high burden countries, under field conditions, including data on the benefits of LTBI management., Objective: To analyze the LTBI diagnosis and treatment cascade among contacts in primary health care (PHC) services in São José do Rio Preto-SP, Brazil., Methods: Cross-sectional design, conducted with contacts of pulmonary TB patients followed in all PHC services. Data was collected from May to September 2014 in the Reporting System for TB cases (TBWEB) and Reporting System for Chemoprophylaxis. Medical records and treatment follow-up forms were reviewed and all the nurses responsible for TB in PHC services were interviewed., Results: Among 336 contacts included, 267 (79.4%) were screened for TB or LTBI, according to the presence or not of respiratory symptoms. Among those contacts screened, 140 (52.4%) were symptomatic, 9 (3.4%) had TB disease, 106/221 (48%) had positive TST result, meeting the criteria for LTBI treatment, and 64/106 (60.4%) actually started it. Overall, among 267 screened, only 64 (24%) started LTBI treatment. The completion rates of treatment among the contacts who started it, those with positive TST result and those screened were 56.3% (36/64), 16.3% (36/221) and 13.5% (36/267), respectively. Nurses claimed that asymptomatic TB contacts pay no attention to preventive health care and do not seek medical care as they do not have symptoms of the disease. In reviewing the medical records, high proportions of contacts without evaluation, incomplete assessment, incorrect records of contraindication for LTBI treatment, lack of notes regarding the identification and evaluation of contacts were identified., Conclusions: There is a need for better organization of the surveillance and investigation routine for contacts in PHC, considering the reorganization of the work process and the features of the local health system.

Objective: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model., Method: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum., Results: The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity., Conclusion: The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge., Objetivo: Analisar,segundo os elementos doChronicCareModel,a produção do cuidado aos casos de tuberculose nos serviços de Atenção Primária à Saúde., Método: Estudo transversal, realizado em capital do nordeste brasileiro, envolvendo 83 profissionais da Estratégia Saúde da Família. Aplicou-se um instrumento estruturado, adaptado para atenção à tuberculose no Brasil. A análise pautou-se na construção de indicadores, cujacapacidade para produção de cuidados variou entre limitada a ótima., Resultados: A organização da atenção à tuberculose e o autocuidado apoiado apresentaram capacidade razoável. Na articulação com a comunidade, a presençadoagente comunitário de saúde apresentou capacidade ótima. A parceria com organizações da comunidade e o envolvimento de especialistas obtiveram capacidade limitada. A capacitação dos profissionais, o sistema de agendamento e monitoramento da tuberculose na comunidade e o sistema de informação clínica alcançaram capacidade básica., Conclusão: A capacidade dos serviços da Atenção Primária à Saúde para produção do cuidado aos casos de tuberculose,segundo os elementos doChronicCareModel,ainda é limitada.Superar a fragmentação do cuidado e priorizar um funcionamento sistêmico entre ações e serviços da rede de atenção à saúde é ainda um grande desafio.

Objective: To analyze nursing practiced in the treatment of tuberculosis, based on secondary data records., Method: Descriptive study of the retrospective survey kind, conducted in Ribeirão Preto, from August to December 2013. The data of 109 electronic and clinical medical records, and a TB reporting system in the state of São Paulo for residents in the municipality monitored in the reference clinics. Descriptive statistic techniques were used., Results: The median of 46.0 (IQ: 17.0 to 96.0) calls throughout the treatment shows the patient's proximity to the health service and professionals, of which the primary persons responsible for follow-ups were nursing assistants (99.1%), which perform the House Visits (71.5%) for patients under a supervision regime (75.2%)., Conclusion: The actions developed with the patients were mostly focused on the nursing staff, making the importance of this category to achieve the indicators related to the Millennium Development Goals for tuberculosis visible.

OBJECTIVE To evaluate the validity and reliability of an instrument that evaluates the structure of primary health care units for the treatment of tuberculosis. METHODS This cross-sectional study used simple random sampling and evaluated 1,037 health care professionals from five Brazilian municipalities (Natal, state of Rio Grande do Norte; Cabedelo, state of Paraíba; Foz do Iguaçu, state of Parana; Sao José do Rio Preto, state of Sao Paulo, and Uberaba, state of Minas Gerais) in 2011. Structural indicators were identified and validated, considering different methods of organization of the health care system in the municipalities of different population sizes. Each structure represented the organization of health care services and contained the resources available for the execution of health care services: physical resources (equipment, consumables, and facilities); human resources (number and qualification); and resources for maintenance of the existing infrastructure and technology (deemed as the organization of health care services). The statistical analyses used in the validation process included reliability analysis, exploratory factor analysis, and confirmatory factor analysis. RESULTS The validation process indicated the retention of five factors, with 85.9% of the total variance explained, internal consistency between 0.6460 and 0.7802, and quality of fit of the confirmatory factor analysis of 0.995 using the goodness-of-fit index. The retained factors comprised five structural indicators: professionals involved in the care of tuberculosis patients, training, access to recording instruments, availability of supplies, and coordination of health care services with other levels of care. Availability of supplies had the best performance and the lowest coefficient of variation among the services evaluated. The indicators of assessment of human resources and coordination with other levels of care had satisfactory performance, but the latter showed the highest coefficient of variation. The performance of the indicators "training" and "access to recording instruments" was inferior to that of other indicators. CONCLUSIONS The instrument showed feasibility of application and potential to assess the structure of primary health care units for the treatment of tuberculosis.

Objective: To analyze the infected person's first contact with the health services, for the early diagnosis of tuberculosis (TB) in different regions of Brazil., Method: a cross-sectional study undertaken in 6 municipalities in the South-east, South and North-east regions of Brazil. Data collection involved secondary sources and interviews with the patients. The data was analyzed using descriptive techniques and multiple correspondence factor analysis., Results: Primary Health Care (PHC) presented the longest time to diagnosis and the lowest proportion of diagnoses. The services associated with diagnosis in the first consultation were the specialized services and the Tuberculosis Control Programs, which offer consultations and tests on-site., Conclusion: For the control of TB, it is necessary to organize the work in an integrated way between the different services' teams. In Primary Health Care, it is also necessary to observe the extent of incorporation and sustainability in the implementation of these actions into the health services' daily practice.

Objective: To identify the factors linked to patients and health services in delays in the diagnosis of tuberculosis., Methods: Epidemiological study in Foz do Iguaçu, Paraná, Brazil, 2009. The Primary Care Assessment Tool, adapted for appraising tuberculosis treatment, was the instrument used. Descriptive statistics techniques were used, such as frequency distributions, central tendency and dispersion measurements (median and interquartile intervals), and odds ratios., Results: There were greater delays in seeking health services for those in the age group 60 years and older, for females, for patients with low levels of education, and for patients with poor knowledge of the disease. Clinical variables (being a new case and HIV infection) and behavioral variables (use of tobacco and alcohol consumption) were not linked with delays in diagnosis. The median time delays before diagnosis attributable to patients and to the health services were 30 days and 10 days, respectively. Emergency 24-hour medical services and primary health care services were not effective in identifying suspicious cases of tuberculosis and requesting tests to confirm the diagnosis, with a high percentage of referrals to the Tuberculosis Control Program clinic., Conclusions: Going to primary health care services for diagnosis increased the time before diagnosis of the disease was reached. The Tuberculosis Control Program clinic was more effective in diagnosis of tuberculosis, due to the training of the staff and to an organized process for receiving patients, including the availability of tests to support the diagnosis.

ABSTRACT: BACKGROUND: Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions. METHODS: This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites. RESULTS: "Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP. CONCLUSIONS: Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.

Objective: To identify areas of vulnerability to new cases of HIV/tuberculosis (TB) co-infection., Methods: An ecological descriptive study was conducted by georeferencing new HIV/TB cases reported in the city of Ribeirão Preto, Southeastern Brazil, in 2006. Data were obtained from the São Paulo state information system for TB notification (TB-WEB) database. New cases of HIV/TB co-infection were analyzed according to sociodemographic and clinical characteristics and, subsequently, georeferenced in the city's cartographic basis, based on home addresses. City sectors were categorized into three socioeconomic levels: lower, average and upper levels, based on the analysis of the main components of the 2000 Demographic Census variables (income, level of education and percentage of households with five or more residents). The incidence of HIV/TB co-infection was calculated for each socioeconomic level., Results: HIV/TB co-infection affected a higher number of economically active adult males and the pulmonary form of TB was the most frequent. Spatial distribution showed that the incidences in areas with average and lower socioeconomic levels (8.3 and 11.5 cases per 100,000 inhabitants, respectively) were higher than that with a higher socioeconomic level (4.8 cases per 100,000 inhabitants)., Conclusions: The incidence rate of HIV/TB co-infection, analyzed according to socioeconomic levels, showed a non-homogeneous spatial pattern of distribution and higher values in more socially vulnerable areas. The present study identified priority geographical areas to control co-infection and revealed that the geographical information system technology can be used by city managers to plan health actions.