03592nas a2200325   4500000000100000008004100001260004400042653001800086653002400104653001700128653001200145653003300157653002200190100001800212700001600230700001400246700001500260700001200275700001400287700001400301700001300315700001400328700001400342245013800356856009000494300000900584490000700593520265200600022001403252       2023                            d  bSpringer Science and Business Media LLC10aHealth Policy10aPrimary Health Care10aTuberculosis10aLeprosy10aCommunicable Disease Control10aHealth evaluation1 aFerreira GRON1 aMiranda ALC1 aFarias VA1 aMartins MB1 aNeri DT1 aBorges WD1 aCunha CLF1 aDias GAR1 aSantos DC1 aSousa FJD00aLeprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil  uhttps://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-023-09842-5.pdf  a1-100 v233 a<p><strong>Background:</strong> In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. Objective To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care.</p>

<p><strong>Methods:</strong> In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3.</p>

<p><strong>Results:</strong>&nbsp;Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p &lt; 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p &lt; 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p &lt; 0.0001) and urban (p &lt; 0.0001); collection of the first sputum sample in urban (p &lt; 0.0001) and adjacent rural areas (p &lt; 0.0001); directly observed treatment (p &lt; 0.0001) in adjacent rural municipalities.</p>

<p><strong>Conclusion:</strong> There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.</p>
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