It is a detectable and curable disease that registers 10 thousand new cases per year in the country. A study points out the barriers that exist to increase success in the treatment of the disease.
March 24 was declared by the World Health Organization (WHO) as World Tuberculosis Day, a detectable and curable disease that in some regions of Argentina constitutes a major public health problem. In our country, every year 10.000 new cases are diagnosed and 700 deaths occur.
“According to the latest statistics from the Ministry of Health of the Nation, this infectious disease that is transmitted through the air (when a patient sneezes, coughs or spits) occurs especially in densely populated areas with unfavorable socioeconomic conditions, such as the suburbs of the province of Buenos Aires, where 48 percent of the new annual cases are concentrated, Salta, Jujuy and (to a lesser extent), Santiago del Estero and Formosa,” says the Dr. Fernando Rubinstein, epidemiologist and academic at the Institute of Clinical and Health Effectiveness (IECS), an Argentine non-profit organization dedicated to health research.
Tuberculosis treatment is provided by the State completely free of charge and consists of taking antibiotics for a period of six months. “When performed correctly, this treatment guarantees the cure of the disease in 95 percent of cases. However, in our country the average success rate does not exceed 75 percent, a figure that is below the health goal established by the WHO, which consists of curing 85 percent of diagnosed cases,” explains the specialist.
DIFFICULTIES
“One of the important barriers we face in tuberculosis is that it has a very long treatment, and during that period, the medication should not be interrupted. Beyond the health problem (which has a high impact on the general condition of the affected individuals), there is a great social stigma around this disease that, many times, impacts the personal relationships and work opportunities of the patients," says Rubinstein.
“Adherence to treatment (many patients abandon it) is a complex and multifaceted phenomenon and the responsibility lies with both patients and the health system,” he says. In this sense, it points out that it is the primary responsibility of the health system to articulate resources in the best possible way to guarantee the continuity and success of treatment in diagnosed patients, as well as the detection of the disease in those individuals who, for different reasons, they do not access health care centers.
“The lack of treatment is not only the individual responsibility of the patient but also a public health problem,” he emphasizes.
These and other insights come from a qualitative study carried out by the IECS in which patients, family members, health team professionals and tuberculosis program coordinators in the province of Buenos Aires were interviewed in depth. This study (which was funded by the Fogarty International Center of the Institute of Health -NIH- in the USA) detects some of the main barriers that the system faces to improve the continuity and effectiveness of tuberculosis treatment.
The points that need to be improved are:
• Extend the hours of care in health centers.
• Improve the implementation of direct incentives to patients during treatment.
• Extend the participation of treatment supervisors to community members or family members.
• Avoid work overload and frequent replacement of health team professionals.
• Provide the resources to guarantee the monitoring of treatment and the search for those patients who interrupt it.
• Achieve better coordination with the primary care network and health centers to deconcentrate the care and monitoring of patients in hospitals.
“In light of the results of this and other studies, we can identify factors in the system that help us overcome in the short term some of the limitations we have today. This way we can evaluate new interventions that aim to improve results in the medium and long term. Health systems have to be dynamic and, as much as possible, respond to the needs of patients. Otherwise, it is very difficult to fulfill our part of the responsibility,” concludes Rubinstein.
World Tuberculosis Day is a global call to action and a way to mobilize the fight against this disease.
THE NUMBERS
• 6000 people die every day from tuberculosis worldwide.
• Worldwide there are more than 2 million deaths per year. That is why it is the infectious disease that causes the greatest number of adult illnesses and deaths.
• Annually 30 out of every 100.000 Argentines present a new case of tuberculosis.
• 10.000 new cases are detected per year, 48% of them concentrated in the province of Buenos Aires (especially in the suburbs).
• The treatment cures 95 percent of patients, but in our country the success of the treatment reaches only 74% and has not improved substantially in the last 10 years.
• In Argentina, 14,5 percent of patients who start treatment annually abandon it, with the risk of worsening of the disease, spread to their contacts and the generation of resistance to drugs, a very serious problem in the world and from which our country does not escape.
Source: WHO.
THE DISEASE IN AREAS
There is significant variability in the notification of the disease between different provinces and surprising differences between different departments of the province of Buenos Aires. The highest rates (ranging between 10 and 80 cases per 100.000 people) are especially recorded in the northeastern region of the province, which corresponds to the Buenos Aires suburbs.
In Argentina, the global average treatment success rate is 74% and the abandonment rate is 14,5%. As can be seen in the graph, these rates have practically not changed in the last 14 years, which means that the disease has not advanced, but we have not improved in control either.
CHARACTERISTICS OF THE DISEASE
• The most vulnerable groups are: the population with unfavorable living conditions from an economic and social point of view, people deprived of their liberty, those affected with HIV and other associated diseases such as diabetes.
• Adherence to treatment, the continuous provision of medications, access to diagnosis and timely treatment constitute the main lines of action in the fight against the disease.
• It is one of the main causes of morbidity and death around the world and constitutes a major health problem for Latin America and Argentina.
CV FERNANDO RUBINSTEIN
Doctor from the University of Buenos Aires (UBA) and specialist in family medicine. He graduated with a Master's degree in Public Health from the Epidemiology and Biostatistics Division of the School of Public Health at California State University, USA.
He was a primary care instructor in internal medicine and an associate researcher at the Clinical Trial Center at the University of California, San Diego, USA. He has worked on various clinical and health services research studies.
He currently serves as academic director of the Institute of Clinical and Health Effectiveness (IECS), and is the deputy director of the Master's Degree in Clinical Effectiveness of the Faculty of Medicine of the UBA. He is also a member of the Clinical Research Committee of the Italian Hospital of Buenos Aires, a staff doctor of the Family and Community Medicine Service, where he works as coordinator of the Clinical Research area.
Press contact: Mariana Comolli: Tel.: (011)4777-8767 mcomolli@iecs.org.ar