Mixed study of the determinants of multidrug-resistant tuberculosis in the state of São Paulo: From the Bayesian approach to the perception of health professionals and patients

Abstract

Multidrug-resistant tuberculosis is a threat to tuberculosis elimination efforts globally, leading to significant impacts on the health of populations and the financially burdening of health systems. Few studies have investigated the cause and regions at greatest risk for the disease, which is an important information to support prevention and control measures. The objective of this study is to analyze the determinants associated with multidrug-resistant tuberculosis in the cities of São Paulo. This is a mixed study conducted in the 645 municipalities of São Paulo, involving a quantitative step and a qualitative step. We will consider all confirmed multidrug resistance cases, residing in the municipalities of São Paulo and registered between 2006 and 2016 in two state databases. We will also use data from the Single Register of Social Programs of the Federal Government (CadÚnico) and Demographic Census of 2010. For the spatial analysis, we will use the Bayesian hierarchical modeling to model the spatial distribution of the Relative Risk of the cases. We will introduce space dependence assuming the conditional autoregressive structure and the unstructured effect we will construct through a normal distribution with zero mean and large variance. For the qualitative stage, we will conduct interviews with multidrug resistance patients. Health professionals will also be included, using the Focal Group as a means of collecting data. We will analyze the qualitative data through the analysis of content thematic modality. The study will advance knowledge by using innovative approaches to understanding multidrug-resistant tuberculosis in the state of São Paulo, enabling prevention, control, more patient-centered attention and health actions focused on the determinants of the disease. (AU)