Mitigating adverse outcomes in tuberculosis treatment: analyzing a non-compliance risk assessment strategy in a case report

• Published in: Revista do Instituto de Medicina Tropical de São Paulo Vol. 66; p. e59
• Main Authors: Melo, Carolina Rossoni de, Volpe-Chaves, Cláudia Elizabeth, Silva, Kássia Raquel da, Roso, João Gabriel Cibolli, Bertucci, Alexandre Albuquerque, Cunha, Eunice Atsuko Totumi, Venturini, James, Andrade, Ursulla Vilella, Peruzzo, Michelle Mocellin, Bezerra, Wanessa da Silva Peres, Oliveira, Sandra Maria do Valle Leone de, Paniago, Anamaria Mello Miranda
• Format: Journal Article
• Language: English
• Published: Brazil Instituto de Medicina Tropical de São Paulo 2024
• Subjects: Adult; Antitubercular Agents - administration & dosage; Antitubercular Agents - therapeutic use; COVID-19; Female; Humans; Male; Medication Adherence; Risk Assessment; TROPICAL MEDICINE; Tuberculosis, Pulmonary - drug therapy; Treatment adherence; Mycobacterium tuberculosis; Risk factors; Pulmonary tuberculosis
• ISSN: 1678-9946; 1678-9946
• DOI: 10.1590/S1678-9946202466059

Tuberculosis (TB) is a global public health concern and a leading cause of death. Its persistence occurs mainly because barriers in the care cascade are not being fully addressed. Healthcare professionals and scientists have been addressing treatment challenges such as abandonment and irregular drug intake via strategies such as directly observing treatment and singular therapeutic projects to improve adherence. However, while protocols and guidelines advocate these strategies, their implementation requires a broader approach from healthcare teams. This article examines the importance of such strategies in clinical TB management and analyzes an unfavorable outcome in an immunocompetent patient treated for pulmonary tuberculosis (PTB) from 2017 to 2022. After recurrence and treatment, the patient continued to have persistent acid-fast bacilli in the sputum, positive cultures for Mycobacterium tuberculosis, and progressive lung lesions, despite receiving the recommended treatment. Although categorized as having an intermediate risk of treatment abandonment, the patient faced challenges, such as the COVID-19 pandemic, pregnancy, and being diagnosed with COVID-19. After therapeutic failure and the loss of beneficial prospects, palliative care was initiated. This case illustrates the complexities of managing TB in patients with recurrent disease despite apparent adherence to treatment. After reassessing the risk of abandonment score, the patient was categorized as high-risk. This underscores the importance of singular therapeutic projects, such as psychological support for high-risk or intermediate patients, to prevent negative outcomes. This case reinforces the critical need for comprehensive patient-centered approaches to successfully treat and manage TB.