Apoio matricial em hanseníase na atenção primária à saúde: potencialidades para qualificação do cuidado em Fortaleza, Ceará

Abstract

Introduction: Leprosy is a chronic neglected infectious disease with significant social, economic, and psychological impacts at both individual and collective levels. Brazil has one of the highest disease burdens in the Americas and worldwide; however, persistent gaps in timely diagnosis and treatment reflect limited prioritization and insufficient investment in public health policies aimed at effective control. Matrix Support (AM), integrated with primary care teams and strengthened by Continuing Education in Health (CEH) and teaching-service integration, represents a promising and essential strategy for enhancing care practices and consolidating surveillance, prevention, and control actions for leprosy within Primary Health Care (PHC). This approach promotes the improved work processes, increased problem-solving capacity among teams, and the shared construction of knowledge-key elements for addressing the disease in high-endemicity settings. Objective: To describe the implementation process of Matrix Support for leprosy care within the PHC system of Fortaleza, considering the epidemiological and operational contexts of disease control. Methods: This descriptive and documentary study, supported by quantitative data analysis, was conducted within the PHC system of Fortaleza. Implementation of AM began through the PEP++ Program (NHR Brazil) and the Leprosy Thematic Strengthening Project (UFC/SVSA-MS/ASTEF), integrating CEH initiatives and Teaching-Service Integration with medical interns and Family and Community Medicine residents. The establishment of the first Matrix Support Service for leprosy and the introduction of asynchronous teleconsultation via the FastMedic® electronic medical record contributed to the consolidation of AM by improving communication between specialists and Family Health Strategy professionals, thereby strengthening team training and the capacity to provide resolutive care. For the quantitative component, epidemiological and operational indicators for leprosy from 2001 to 2024 were analyzed using official data from the Notifiable Diseases Information System (SINAN). Results: Throughout the AM implementation process, training activities and the structuring of the Matrix Support Service expanded the operational capacity of the primary care network. Teaching–service integration was strengthened through the expansion of internship and residency training sites for medical students and Family and Community Medicine residents. Two concrete technical products were developed: the Leprosy Care Pathway (Appendix A) and the Municipal Epidemiological Bulletin (Appendix B), which consolidated care flows and surveillance strategies. From an epidemiological perspective, a change was observed in the profile of newly diagnosed cases across reporting units: previously, most diagnoses were made at the state referral center; after the implementation of the Matrix Support (AM), the distribution became more balanced, with approximately 50% of cases diagnosed in primary health care (PHC) and 50% in referral units, demonstrating improved care resolvability at the PHC level. Conclusion: The structuring of Matrix Support for leprosy in Fortaleza‘s PHC proved viable and sustainable, strengthening primary care in delivering effective and resolutive management of the disease. AM emerges as an innovative and promising public health strategy capable of improving care for affected individuals within the Brazilian Unified Health System (SUS) while effectively integrating epidemiological surveillance actions. Remaining challenges include the need to train additional matrix supporters to expand coverage and consolidate the model. The experience may also serve as a reference for other health areas and municipalities, contributing to improved problem-solving capacity and greater integration among teams and services.