El deterioro de la tuberculosis en Chile

Resumen

Background: Recent data suggest an increase in tuberculosis (TB) incidence in Chile. Aim: To evaluate recent epidemiological trends, geographic extension and potential factors associated with TB reemergence in Chile. Material and methods: Data analysis from official sources and trend analysis. Results: TB incidence rate increased from 12.3 (2014) to 14.7 (2016) per 100.000 inhabitants. Morbidity rates also increased in nine out of 15 regions. The proportion of TB cases in specific groups has also increased in the last six years: HIV/AIDS (68%), immigrants (118%), drug users/alcoholics (267%) and homeless people (370%). Several indicators of the national TB program performance have deteriorated including TB case detection, HIV co-infection study and contact tracing activities. Overall results indicate a higher than expected case-fatality ratio (>3%), high rates of loss from follow-up (>5%), and low percentage of cohort healing rate (<90%). This decline is associated with a Control Program with scarce human resources whose central budget decreased by 90% from 2008 to 2014. New molecular diagnostic tools and liquid media culture were only recently implemented. Conclusions: TB trends and overall program performance indicators have deteriorated in recent years in Chile and several factors appear to be involved. Multiple strategies will be required to rectify this situation.