Avaliação da implantação das medidas de controle da tuberculose no sistema prisional da região metropolitana de Natal

Abstract

Introduction: It is estimated that every year, 10 million people develop tuberculosis worldwide. Among People Deprived of Liberty, the incidence of the disease is 26 times higher than in the general population. Prison units function as reservoirs, influencing the alarming illness rates among individuals in this context. Objective: To evaluate the influence of the prison units in the Metropolitan Region of Natal on the implementation of tuberculosis control actions. Method: This is an evaluative research study based on the Hartz perspective. The theoretical framework was anchored in Donabedian’s model as a basis for normative evaluation. The investigation was carried out in the prison units of the Metropolitan Region of Natal. Data collection took place in July 2025. The study population consisted of professionals from the Prison Health Teams and health surveillance managers from each city involved. Data were collected using a questionnaire developed by researchers and professionals working in the tuberculosis field. Quantitative data were organized and processed using the Statistical Package for Social Sciences (SPSS Statistics®) version 22.0, and presented through descriptive and inferential statistics, using both mean values and the degree of implementation of disease control actions in the prison units. Additionally, a logistic regression model was developed to identify factors associated with the degree of implementation related to the Structure and Process dimensions of actions in the prison context. Open-ended questions included in the questionnaire were processed through lexicographic analysis using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRaMuTeQ) software and subsequently analyzed using Bardin’s content analysis. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte under protocol number 7.612.481. Results: Of the 60 professionals selected, 48 participated in the final sample. Most participants were linked to the Cadeia Pública Dinorá Simas Lima Deodato (25.0%), Ceará-Mirim and the Penitenciária Estadual de Alcaçuz (22.92%), Nísia Floresta, followed by the Penitenciária Estadual de Parnamirim (18.75%) and the Complexo Penal Doutor João Chaves (12.50%) in Natal. A smaller proportion worked at the Centro de Detenção Provisório de Parnamirim (8.33%). The degree of implementation of tuberculosis infection control actions in prison units was classified as partially implemented (53.1%). The dimensions related to Structure and Process were also classified as partially implemented (52.25% and 55.06%, respectively). In the Structure dimension, the sub-dimension of administrative measures was partially implemented (71.9%), environmental control measures were not implemented (8.33%), and respiratory protection measures were partially implemented (65.9%). In the Process dimension, administrative measures (70.42%) were also partially implemented. The factors associated with the degree of implementation identified through the logistic regression model were: the use of the Respiratory Symptomatic Register Book, the existence of a differentiated schedule for suspected cases, and the presence of a tuberculosis control plan in the context. Conclusion: The degree of implementation of tuberculosis control actions in prison units was classified as partially implemented. This scenario highlights the need to strengthen actions, especially regarding the full adoption of disease control measures, to ensure the effectiveness of prevention and control strategies in the prison environment with the engagement of all actors involved. Furthermore, the prison context itself influences tuberculosis control actions, creating barriers to their full implementation and, consequently, affecting efforts to reduce disease transmission.