Tuberculosis control in a highly endemic indigenous community in Brazil

In Latin America, indigenous populations have high rates of non-completion of TB treatment and case fatality and have been defined as a priority group for investments. To evaluate TB control, a retrospective cohort study was performed to identify factors predictive of non-completion of treatment and mortality in an indigenous and non-indigenous population between 2002 and 2008 in Dourados, Brazil. A 90% reduction in non-completion of TB treatment was observed in the indigenous population after DOTS (directly observed treatment, short course) implementation (20% vs 2%). In the non-indigenous population, the number of patients not completing TB treatment continued to increase. Non-indigenous TB patients had 4.5 times higher mortality than indigenous TB patients (9% vs 2%). In multivariate analysis, non-indigenous race [odds ratio (OR) 2.33, 95% CI 1.32-4.10] was associated with non-completion of TB treatment, and HIV-positive status (OR 5.58, 95% CI 2.38-13.07) was associated with mortality. Implementation of DOTS in the indigenous populations in Dourados showed a significant reduction in non-completion of TB treatment. Nevertheless, a high rate of TB in children and young adults indicates the continuous transmission and maintenance of the epidemic in this community. Among the non-indigenous population, the TB case fatality rate is closely linked to the HIV prevalence.