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OBJETIVO: Estimar o tempo entre o início dos sintomas e o início do tratamento de pacientes com tuberculose pulmonar virgens de tratamento e com resultado positivo na baciloscopia direta do escarro, assim como avaliar as variáveis associadas à demora no diagnóstico e no início do tratamento. MÉTODOS: Estudo descritivo exploratório em pacientes virgens de tratamento para tuberculose, com idade > 12 anos e resultado positivo para BAAR no escarro. Entre 2006 e 2008, os 199 pacientes incluídos no estudo foram entrevistados, e seus exames complementares foram revisados no momento da consulta para o início de tratamento para tuberculose em uma unidade básica de saúde no município de Nova Iguaçu (RJ). RESULTADOS: As medianas (e seus respectivos intervalos interquartílicos) para o tempo entre o início dos sintomas e o início do tratamento, o tempo até a procura por atendimento médico, o tempo até o diagnóstico e o tempo até o início do tratamento, em semanas, foram, respectivamente, 11 (6-24), 8 (4-20), 2 (1-8) e 1 (1-1).As variáveis gênero, idade, escolaridade, uso prévio de antibióticos, status HIV, local da primeira consulta médica e extensão radiológica da doença não se associaram ao tempo até o diagnóstico ou ao tempo até o início do tratamento. A principal razão para a demora dos pacientes em procurar o serviço de saúde foi sua dificuldade em reconhecer seus sintomas como indicativos de doença. CONCLUSÕES: Os tempos até o diagnóstico e até o início do tratamento para tuberculose foram inaceitavelmente longos na amostra estudada.OBJECTIVE: To estimate the time elapsed between the onset of symptoms and the initiation of treatment of pulmonary tuberculosis among treatment-naïve patients with positive results in sputum smear microscopy, and to evaluate the variables associated with delays in diagnosis and in treatment initiation. METHODS: This was a descriptive exploratory study involving 199 treatment-naïve tuberculosis patients > 12 years of age with AFB-positive sputum smear microscopy results between 2006 and 2008. At their first (treatment initiation) visit to a primary health care clinic in the city of Nova Iguaçu, Brazil, the patients were interviewed and their ancillary test results were reviewed. RESULTS: The medians (and respective interquartile ranges) of the time from symptom onset to the initiation of treatment of pulmonary tuberculosis, from symptom onset to seeking medical attention, from entry into care to diagnosis, and from entry into care to treatment initiation, in weeks, were 11 (6-24), 8 (4-20), 2 (1-8), and 1 (1-1), respectively. The variables gender, age, level of education, previous use of antibiotics, HIV status, site of first medical visit, and radiological extent of tuberculosis showed no associations with the time from entry into care to diagnosis and to treatment initiation. The main reason for the delay in seeking medical attention reported by the patients was their inability to recognize their symptoms as indicators of a disease. CONCLUSIONS: Among the patients studied, there was an unacceptably long delay between the onset of symptoms and the initiation of tuberculosis treatment.

ABSTRACT: Introduction: The mortality rate among tuberculosis patients (TB fatality) has been attributed to irregular chemotherapy, delay in diagnosis, multidrug resistance, and HIV coinfection. Objective: To analyze TB fatality rates by sex, clinical presentation and HIV coinfection in Campinas, São Paulo, Brazil. Methods: Cohorts of residents in the city of Campinas who either died during treatment for tuberculosis or had the disease confirmed after death were divided into three intervals: 2001-2003, 2004-2006, and 2007-2009. Data were obtained from the database of the Tuberculosis Surveillance System of the University of Campinas, and notifications were gathered through TB-WEB Health São Paulo Secretary. Statistical significance was determined using a chi-square test, considering p < 0.05. Results: Between 2001 and 2009, 3,416 TB patients were diagnosed: 2,827 (82.8%) were new TB cases and 589 (17.2%) were retreatments. Between the first and second triennium, the number of new patients decreased by 18%, and 23% among retreatments. Between the second and third intervals, the reduction was 5% and 21%, respectively. General case fatality rate declined from 11.4% to 9.9% across intervals, and was most significant among patients that had previously abandoned treatment (17.3% to 5.1%). Fatality rates among patients coinfected with TB-AIDS were 2-3 times that of patients not infected with TB-AIDS throughout the intervals. Fatality between the first and third triennium among TB-AIDS co-infected patients declined (24.8% to 19.5%), while increasing slightly among non-AIDS TB patients (7.3% to 8%) during this period. Conclusion: Though mortality among TB-AIDS patients declined from 2001-2009, rates among non-AIDS TB remained stagnant. Improved TB diagnosis and treatment is needed to further decrease TB mortality in Campinas.