The Abandonment of the Treatment of American Tegumentary Leishmaniasis: The Need for the Strengthening of Primary Care

Introduction: Governador Valadares is an endemic area of American Tegumentary Leishmaniasis where the detection rate was 15.36 per 100.000 inhabitants in the period from 2001 to 2006.

Objective: To identify the reasons for abandonment of ATL treatment.

Methodology: Individuals diagnosed with ATL in the period between January and December 2009. Regarding the organization of the care of ATL, the clinical and laboratory diagnosis is performed in a specialized service center, and drug administration is performed at the basic health care units, except on weekends when the patients should go to the hospital (Hospital Municipal) in order to have the drug administered.

Results: The study included 40 patients, 26 (65%) males and 13 females (32.5%). It was observed that 72.50% of the patients had regular treatment and 82.50% of the patients returned monthly for evaluation of clinical cure for three consecutive months. Regarding the clinical evolution of patients, 67.50% of the participants had clinical cure, 22.50% were not cured, and 10% abandoned the treatment. Regarding the latter, the reasons were: a 75-year-old felt intense adverse effects to the drug and did not return for evaluation; at the basic health care unit close to their homes, two other patients reported that there was no input for drug administration and it would be necessary to seek another health care center, which was financially unfeasible; there was a case in which the patient had the treatment regimen as prescribed, but did not return for evaluation of clinical cure.  In all cases, the health visitor made the contact via telephone or home visit, but the patients did not return for the scheduled appointments.

Conclusion: The cases of abandonment could have been avoided or decreased if actions were taken in order to strengthen primary attention given to the treatment or monitoring of patients with ATL.