DOI: 10.1590/S0080-623420140000700011 O RIGINAL The distribution of tuberculosis in Porto Alegre: analysis of the magnitude and tuberculosis-HIV coinfection A RTICLE DISTRIBUIÇÃO DA TUBERCULOSE EM PORTO ALEGRE: ANÁLISE DA MAGNITUDE E COINFECÇÃO TUBERCULOSE-HIV DISTRIBUCIÓN DE LA TUBERCULOSIS EN PORTO ALEGRE: ANÁLISIS DE LA MAGNITUD Y COINFECCIÓN TUBERCULOSIS-VIH Rarianne Carvalho Peruhype1, Lisiane Morelia Weide Acosta2, Antônio Ruffino-Netto3, Mônica Maria Celestina de Oliveira4, Pedro Fredemir Palha5 ABSTRACT RESUMO RESUMEN Objective: Analyzing the geographical Objetivo: Analisar a distribuição geográfica Objetivo: Analizar la distribución geográ- distribution of the tuberculosis (TB), its da doença, sua incidência, prevalência e a fica de la enfermedad, su incidencia, pre- incidence and prevalence and TB-HIV coinfecção TB - HIV nos bairros deste mu- valencia y la coinfección TB - VIH en los coinfection in the districts of Porto Alegre nicípio nos anos de 2007 a 2011. Método: barrios de este municipio en los años de from 2007 to 2011. Method: An ecologi- Estudo ecológico de série histórica, des- 2007 a 2011. Método: Estudio ecológico cal, descriptive study of time series that critivo, que utilizou técnicas descritivas e de serie histórica, descriptivo, que utilizó used descriptive and geoprocessing tech- de geoprocessamento. Resultados: Foram técnicas descriptivas y de geoprocesamien- niques. Results: In total, were recorded registrados 3.369 casos novos e 3.998 ca- to. Resultados: Fueron registrados 3.369 3,369 incident cases and 3,998 prevalent sos prevalentes de tuberculose pulmonar casos nuevos y 3.998 casos prevalentes de cases of pulmonary TB. In both contexts, bacilífera. Em ambos os contextos houve tuberculosis pulmonar bacilífera. En ambos there was predominance of cases in ma- predominância de casos no sexo mascu- contextos hubo predominancia de casos en les and in Caucasians. Seventeen districts lino e na etnia branca. Dezessete bairros el sexo masculino y la etnia blanca. Dieci- showed prevalence rates above 79.2 ca- apresentaram taxas de prevalência acima siete barrios presentaron índices de pre- ses/100,000 inhabitants, considering that de 79,2 casos/100.000 habitantes, sendo valencia superiores a 79,2 casos/100.000 15 of them had incidence rates above 73.7 que 15 deles tiveram incidência acima de habitantes, siendo que 15 de esos tuvieron cases/100,000 inhabitants. The TB-HIV 73,7 casos/100.000 habitantes. A taxa de incidencia arriba de 73,7 casos/100.000 coinfection rates reached 67% in some dis- coinfecção TB-HIV chegou a 67% em alguns habitantes. El índice de coinfección TB-VIH tricts, which is above the city average value bairros, valor superior à média da cidade alcanzó el 67% en algunos barrios, valor (30%). Conclusion: The distribution analy- (30%). Conclusão: A análise de distribuição superior al promedio de la ciudad (30%). sis showed that the reformulation and res- apontou que são fundamentais reformula- Conclusión: El análisis de distribución tructuring of policies and health services in ções e reestruturações de políticas e servi- señaló que son fundamentales las refor- Porto Alegre are essential. ços de saúde em Porto Alegre. mulaciones y reestructuraciones de polí- ticas y servicios de salud en Porto Alegre. DESCRIPTORS DESCRITORES DESCRIPTORES Tuberculosis Tuberculose Tuberculosis HIV HIV VIH Residence characteristics Distribuição espacial da população Distribución espacial de la población Public health nursing Enfermagem em saúde pública Enfermería en salud pública 1 PhD Student, School of Nursing of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. 2 Nurse, General Coordination of Health Surveillance, City Hall of Porto Alegre, Porto Alegre, RS, Brazil. 3 Professor, Faculty of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. 4 Professor, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil. 5 Associate Professor, School of Nursing of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. Rev Esc Enferm USP Received: 04/01/2014 The distribution of tuberculosis Portuguêsin Porto Alegre: / Inglês analysis 2014; 48(6):1032-40 Approved: 08/26/2014 of the magnitude and tuberculosis-HIVwww.scielo.br/reeusp coinfection 1032 www.ee.usp.br/reeusp/ Peruhype RC, Acosta LMW, Ruffino-Netto A, Oliveira MMC, Palha PF INTRODUCTION METHOD Tuberculosis (TB) is a disease known as a global This is an ecological, descriptive study of time series, public health problem and of wide geographic distribu- which used geoprocessing (GIS) techniques to map the dis- tion. It is strongly associated with poverty and social tribution of TB and TB-HIV cases in Porto Alegre. The study inequalities and has affected the most different popula- population consisted of patients with bacilliferous pulmo- tion groups(1). nary TB notified in Porto Alegre in the period 2007-2011. In 1993, the World Health Organization (WHO) de- Data were extracted from the Tuberculosis Notifica- clared the alarming situation of TB, inviting govern- tion/Investigation Forms of the Notifiable Diseases -Infor ments, the scientific community and civil society to focus mation System (SINAN – Sistema Nacional de Agravos de urgent efforts to control it(2-3). In recent decades, there Notificação). Data collection was carried out in November has been significant progress on actions and programs 2012 with the municipal agency of General Coordination to combat tuberculosis, a curable infection that still has of Health Surveillance (CGVS – Coordenadoria Geral de high rates of incidence and deaths in several countries - Vigilância em Saúde) in Porto Alegre, in the Communica- it is estimated that in 2012, 8.6 million people developed ble Disease Surveillance team. the disease and 1.3 million died from it(4). The spreadsheet and the database were organized Brazil is among the 22 countries estimated to con- through Microsoft Excel (2010 version) and the SPSS (ver- centrate 80% of TB cases in the world(5), recording sion 19), also used for statistical analysis. For the GIS, it 71,930 new cases of the disease in the year 2010, in was used the TerraView software (version 4.2 and 4.2.1). (6) a proportion of 37.7 cases / 100,000 inhabitants . The new cases of pulmonary TB in Porto Alegre resi- In the country, the homeless, deprived of freedom, dents were selected for the incidence database. For the indigenous and carriers of Human Immunodeficiency prevalence database were selected all types of entries, Virus (HIV) and Acquired Immunodeficiency Syndrome among which new cases, cases of readmissions after (AIDS) are considered the most vulnerable populations treatment abandonment and relapses. In both incidence (7) to the disease . and prevalence databases, were chosen the cases of bacil- Porto Alegre, located in the state of Rio Grande do liferous pulmonary TB and/or pulmonary TB plus extrapul- Sul (RS), is one of the Brazilian capitals with higher in- monary TB with positive bacilloscopy (smear). The disease cidence rates of tuberculosis. In this municipality, the cases of those institutionalized in prison or social system recent annual incidence rates of the disease have been were excluded because this population has an increased more than 100 cases / 100,000(8) inhabitants, consid- risk for TB compared to the general population. Those ered a high level of epidemiological risk(9). Further- with diagnosis change in the case closure (for not being more, both the state of RS as its capital Porto Alegre TB cases) were also excluded. For the calculation of preva- have been prominent in the Brazilian scenario regard- lence were removed the death cases registered in the pe- ing the high rates of TB-HIV coinfection, around 20% riod of the study (2007-2011). and 30%, respectively. These values ​​far exceed the na- The incidence and prevalence of TB, TB-HIV co-infec- tional rate (not exceeding 10%), constituting a worrying tion, age, sex, race, education were analyzed, as well as scenario that requires joint actions of prevention and the completion of the Directly Observed Treatment (DOT) care. Factors such as the growth of pockets of poverty, of bacilliferous pulmonary tuberculosis. the breakdown of health services and the spread of AIDS may help to explain such numbers(8). It was considered the division of Porto Alegre in 82 districts, being 77 officials encoded by the Brazilian Insti- Thus, in view of the severity of TB in Porto Alegre, tute of Geography and Statistics (IBGE) and five unofficial the objective of this analysis was to determine the geo- districs not yet recognized by that court but cataloged by graphic distribution of the disease by city districts, its the CGVS (districts of Aberta dos Morros, Chapéu do Sol, incidence rates and the average prevalence observed Jardim Floresta, Passo das Pedras and Protásio Alves). Be- in the period 2007-2011, as well as knowing the TB-HIV cause the data were more complete, it was used the digi- coinfection. From the behavior of the disease in the city tal grid provided by the CGVS (Figure 1) to do the analysis in recent years, we started with the assumption that by districts and the digital map from the Data Processing there are districts with higher rates of incidence and Company of Porto Alegre – PROCEMPA, in a file named prevalence of TB because of their social indicators. mapadosbairrosvigentes.shp, created and made available on August 3, 2010. Due to the lack of geoprocessing studies of this na- ture regarding the city in