Implementation Contexts of a Tuberculosis Control Program in Brazilian Prisons

To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects.

A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons.

The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases.

The implementation degree and its contexts - external and political-organizational dimensions - simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons.

Table 3 Case 1: final status of tuberculosis cases in all prisons. Brazil, 2014. 

Year of diagnose	Ignored/Blank		Cured		Treatment abandonment		Tuberculosis-related death		Death due to other causes		Transference		Total cases
	n	%	n	%	n	%	n	%	n	%	n	%
2007	19	10.3	120	65.2	32	17.4	5	2.7	8	4.4	0	0	184
2008	69	7.4	731	78.3	102	10.9	3	0.3	27	2.9	2	0.2	934
2009	507	30.6	1,015	61.2	96	5.8	11	0.6	23	1.4	7	0.4	1,659
2010	1,180	71.7	391	23.7	35	2.1	4	0.2	36	2.2	1	0.1	1,647
2011	113	5.8	1,665	85.2	124	6.3	10	0.5	36	1.8	7	0.4	1,955
2012	619	29.9	1,305	62.9	110	5.3	8	0.4	26	1.3	5	0.2	2,073
Total	2,507	29.7	5,227	61.8	499	5.9	41	0.5	156	1.9	22	0.3	8,452

Source: Information System on Diseases of Compulsory Declaration (SINAN) (cited 2014 Feb 27).

Table 4 Case 2: final status of tuberculosis (TB) cases in all prisons. Brazil, 2014. 

Year of diagnose	Ignored/Blank		Cured		Treatment abandonment		Tuberculosis-related death		Death due to other causes		Transference		MDR		Total cases
	n	%	n	%	n	%	n	%	n	%	n	%	n	%
2007	531	72.1	136	18.5	38	5.2	9	1.2	3	0.4	19	2.6	0	0	736
2008	720	85.6	77	9.1	17	2.0	11	1.3	3	0.4	13	1.5	1	0.1	842
2009	693	84.2	76	9.2	24	2.9	6	0.7	6	0.7	18	2.2	1	0.1	824
2010	615	93.9	16	2.4	8	1.2	2	0.3	5	0.8	9	1.4	0	0	655
2011	64	7.9	506	62.7	91	11.3	11	1.4	18	2.2	116	14.4	1	0.1	807
2012	298	44.4	249	37.1	57	8.5	15	2.2	8	1.2	42	6.3	2	0.3	671
Total	2,921	64.4	1,060	23.4	235	5.2	54	1.2	43	0.9	217	4.8	5	0.1	4,535

Source: Information System on Diseases of Compulsory Declaration (SINAN) (cited 2014 Feb 27).

MDR: Multiple drug resistance

Full article at: http://goo.gl/nS65nG

By: de Oliveira LG1, Natal S2, Camacho LA3.

• 1Departamento de Planejamento em Saúde, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, RJ, BR.
• 2Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC, BR.
• 3Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, BR.  

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