Entre diretrizes e práticas: avaliação da implementação do tratamento diretamente observado da tuberculose

Abstract

General Objective: To evaluate the implementation of Directly Observed Treatment (DOT) for tuberculosis in the Primary Health Care Units (PHCU) of the Regional Health Coordination 1 (RHC) of Fortaleza. Specific Objectives: (1) to analyze the compliance between the practices adopted by health professionals and the guidelines/recommendations of the Ministry of Health in carrying out the DOT; (2) to identify challenges, potentialities, and strategies in implementing DOT. Method: This is an exploratory study, with a qualitative approach, carried out through semi-structured interviews with professionals from the PHCU of RHC 1 in Fortaleza. The sampling was intentional, involving eight community health agents and eight nurses responsible for the Tuberculosis Control Program in the PHCU. Data were collected through an online questionnaire (Google Forms), which had the script divided by thematic categories and analyzed based on the axes: (1) Knowledge about the topic; (2) Implementation of the DOT, and (3) Challenges in DOT Implementation. Results: The results indicate that although professionals recognize the importance of DOT, there are gaps in technical knowledge and daily practice. The implementation proved to be heterogeneous, with a lack of systematization and neglect of relevant steps, which are provided for in the Ministry of Health's guidelines. Furthermore, social and organizational challenges compromise the effectiveness of the strategy. There are also weaknesses in monitoring and evaluation efforts. Conclusion: The effectiveness of DOT depends on the technical qualification of teams, the standardization of practices, and the adoption of structured work plans. The study addresses the importance of continuing education and proposes practical actions to strengthen the strategy in the PHCU.