Tuberculosis: Liaison between Hospitals and Ambulatory TB Centres

Introduction: The incidence of tuberculosis (TB) in Portugal in 2015 reached 20 cases/100000 inhabitants defining us as a low incidence country. Various factors have contributed for this scenario, one of them being the close liaison between hospitals and ambulatory TB centres (ATBC), where patients are diagnosed, screened and treated for TB. At ATBC of Venda Nova (ATBCVN) a 700000 population is attended to. Aims and Methods: The authors evaluated, in 2015, the origin and clinical characteristics of patients attended at ATBCVN; patient accessibility to the centre; length of time between initial symptoms and first appointment (at any healthcare facility) and time between initial symptoms and beginning of treatment. Results: Of a total of 192 patients with TB (63% were men), 68% presented pulmonary TB (PTB). Concerning habits, 43% had alcohol abuse history and 39% drug abuse. Regarding comorbidities, 39% had HIV; 13% cancer and 48% presented other diseases. 92% of patients were originally sent to the ATBCVN from various hospitals in Lisbon and 88% of patients were first attended at the ATBCVN in 2 days or less. The average time between initial symptoms and first appointment was 67 days (min 0; max 406 days) and the average between first symptoms and beginning of treatment was 88 days (min 4; max 431 days). Genetic resistance screening was made in 59% of PTB with 3% of resistance to isoniazid and rifampicin; 34% only sensible to rifampicin; 1% only sensible to isoniazid and 61% sensible to both. Conclusion: The ATBCVN has a good accessibility. However, many patients seek medical advise after a long period of time with symptoms, which may delay the whole process. An important number of MDR patients were observed.