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Abstract #161939

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Ann C. Miller, PhD, MPH¹, Elizabeth C.C. Soares, MD², Jonathan E. Golub, PhD, MPH³, Zilma Fonseca², Betina Durovni, MD², Larry H. Moulton⁴, Richard E. Chaisson, MD³, and Solange C. Cavalcante, MD, MS². (1) Bloomberg School of Public Health, Dpt. of Epidemiology, Johns Hopkins University, Center for TB Research; 1820 Lancaster St., Suite 300, Baltimore, MD 21231, 443-388-3587, amiller@jhsph.edu, (2) Tuberculosis Control Program, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, R. Afonso Cavalcanti 455, Room 856, Rio de Janeiro, Brazil, (3) School of Medicine, Division of Infectious Diseases, Johns Hopkins University, 1550 Orleans St., Center for TB Research; CRB-2 Room 1M.07, Baltimore, MD 21231, (4) Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205

Background: Active case finding for tuberculosis (TB) has not historically been part of the WHO's TB control policy because prior studies have suggested that people with TB symptoms seek care, but aren't diagnosed. Identifying whether blocks to case detection occur because patients don't seek care or providers don't diagnose TB is crucial to setting policy for TB control. This analysis evaluates whether people with TB symptoms in the high-incidence Brazilian favela, Rocinha, seek care. Methods: As part of an active case finding intervention, 7 neighborhoods of the favela were randomly allocated to receive door-to-door TB symptom screens by community health workers using standardized data collection tools. Factors potentially affecting care-seeking behavior were evaluated, including gender, age, history of TB, contact status and duration of cough. Interactions were assessed. Univariate analysis and GEE were performed in STATA 8.Results: 23,801 people in 7937 houses were surveyed. Of 1310 people reporting cough, 111 (8.5%) acknowledged seeking help for their symptoms. Of 430 people with a cough of 3 or more weeks, 66 (15.4%) had sought care. Of variables mentioned above, only younger age groups (0-5 and 6-15) (Odds ratio(OR)and 95%CIs 5.37(3.00,9.62)and 2.80 (1.44, 5.44) respectively) and duration of cough (3 weeks or more) (OR 4.84, 95%CI 3.09, 7.56), were significantly associated with increased odds of care seeking. Discussion: In this favela setting, adults, who are more likely to transmit infection than children, are not seeking treatment for their respiratory symptoms. Increasing case detection in symptomatic adults will be of value in this setting.

Learning Objectives:

The participants will be able to
• identify 3 factors associated with seeking care for respiratory symptoms
• describe specific factors associated with seeking care for respiratory symptoms in residents of an urban slum in Rio de Janeiro

Keywords: Tuberculosis, Health Care Utilization

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

• Audio (mp3) recording
• Slides (pdf) or Handout
• Multimedia recording