Monitoramento e avaliação, educação permanente e tecnologias em saúde : desenvolvimento de estratégias para o controle das doenças infectocontagiosas na população privada de liberdade.

Abstract

The Population Deprived of Liberty (PPL) is considered a vulnerable group, especially due to precarious living conditions, the high prevalence of infectious and contagious diseases and the difficulty in accessing health services. The prison health policy must consider the specificities of the PDL and ensure access to comprehensive and equitable care. The general objective of this thesis was to contribute to the state management of the State Policy for Primary Health Care for Persons Deprived of Liberty in the Prison System, within the scope of the Unified Health System (SUS) in Rio Grande do Sul (RS). The methodological proposal divided the work into three axes and resulted in five manuscripts/articles, one published and one accepted for publication. The 1st Axis focuses on monitoring and evaluating infectious diseases in the prison system; the 2nd Axis deals with the development, intervention and evaluation of the Permanent Health Education Program - Prison System (PEPSSP); and the 3rd Axis presents a technical product, the application called PPLife, developed for workers in the prison system. Manuscript I: EFFECTS OF PUBLIC POLICIES AND TARGETED STRATEGIES IN THE CURE OF TUBERCULOSIS IN THE PRISON SYSTEM – Objective: To identify the effects of public policies and targeted strategies on curing tuberculosis in the prison system. Materials and Methods: The research consists of a retrospective, observational, descriptive epidemiological study, using tuberculosis (TB) notification data from the National Notifiable Diseases System (SINAN). The effect of individual variables and policies and strategies on the cure of TB in the prison system were analyzed by multivariate logistic regression considering significant values for p <0.05 and 95% confidence interval. Results: A total of 3415 cases of TB were reported in PPL in Rio Grande do Sul (RS) during the study period. Prison primary care teams (eAPP) were the reporting source in 1587 (47.8%) cases considered for analysis. The following were associated with not curing TB: notifications by other health teams (OR = 1.48; 95%CI: 1.25-1.75); admissions due to transfers (OR = 1.83; 95%CI: 1.39-2.41) and re-entry after dropping out (OR = 1.46; 95%CI: 1.12-1.89); diagnoses by sputum culture (OR = 1.45; 95%CI: 1.02-2.07), TRM (OR = 1.57; 95%CI: 1.31-1.89), histopathology (OR = 1.36; 95%IC: 1. 06-1.75) and clinical epidemiological (OR = 2.24; 95%CI: 1.47-3.41); self-administered treatment (OR = 1.98; 95%CI: 1.63-2.41); and living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/Aids) (OR = 1.57; 95%CI: 1.24-1.98). Conclusions: The effect of public policies and strategies aimed at curing tuberculosis overlap with the individual dimension in PDL in RS. Article II: PERMANENT HEALTH EDUCATION AND THE ACTORS OF THE PRISON SYSTEM IN THE PANDEMIC SCENARIO - Permanent Health Education (EPS) legitimized health education based on meaningful learning, daily work experiences and problem solving collectively and is based on the Teaching-Management-Attention-Social Control Quadrangle. The Covid-19 pandemic required new ways of doing health and education, especially in the prison system, where overcrowding is an impediment to social isolation. This study aimed to identify, through virtual conversation circles, the challenges encountered in daily work and discuss proposals for intervention with the actors of the prison system in the pandemic period, from the perspective of the EPS. A qualitative research approach was used with a descriptive, interpretive and comprehensive analysis of the social phenomenon, through Minayo's thematic content analysis. From the thematic content analysis, four categories emerged based on the EPS Quadrilátero: challenges of health care in the prison system in the context of the Covid-19 pandemic; challenges for health management in prisons; dialogue between HEIs and the prison system and social control and family representation. The virtual conversation circles provided in-depth discussions and collective constructions. The intersectoral and interdisciplinary organization allowed reflections on practices and advances in knowledge and in the direction of qualification of health care in the prison system. The EPS promoted changes in the state's prison health, becoming a relevant device to point out ways and new ways of doing health in the prison system. Manuscript III: PERMANENT HEALTH EDUCATION AS A TUBERCULOSIS CONTROL STRATEGY IN THE PRISON SYSTEM - This Letter to the Editor aims to present preliminary results of an intervention carried out with professionals from the prison system of Rio Grande do Sul, through Permanent Health Education, with focus on tuberculosis. The Permanent Health Education Program was composed of lives, virtual conversation circles and virtual gymkhana. The lives presented the content, the conversation wheels allowed discussion in the 7 Macroregions of the state of Rio Grande do Sul and the gymkhana encouraged practical actions in the prison context. The teams discussed the concept of the disease, its transmission, ways to avoid it and the identification of respiratory symptoms. The importance of adherence to treatment, the proper form of sputum collection and diagnosis and the conduct to be taken after the suspicion of TB were emphasized. The teams participating in the virtual competition replicated permanent health education activities in their daily contexts, established partnerships with educational institutions, carried out a survey of TB and HIV control indicators, actively searched for cases and updated diagnostic, monitoring and treatment. The preliminary evaluations point to the valorization of experiences, exchange of experiences and significant learning, fundamental conditions for solving problems in the daily life of penal institutions and for coping with tuberculosis and other complexities that affect the population deprived of liberty. Manuscript IV: APPLICATIONS RELATED TO HEALTH CARE IN THE PRISON SYSTEM: A SYSTEMATIC REVIEW AND META-SYNTHESIS – Objective: To identify applications related to health care in the prison system. Methodology: A systematic literature review was carried out by consulting the following databases: PubMed, IEEE xplore Digital library, LILACS, Google Scholar, SciELO, Science Direct, ACM Digital Library, PROQUEST - Applied Social Sciences, Scopus, Compendex, Web of Science, CINAHL and The Cochrane Controlled Trials Register. Three independent researchers searched for publications considering the research question: "What are the applications used in health care in the Prison System?" human beings, aged over 18 years and full text available. The articles were organized by the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Result: Five studies were found regarding the use of APP in the prison system, three of them developed and tested for usability and four of them focused on the period of social reintegration. Conclusion: No applications were found that deal with infectious diseases in the prison population. Manuscript V - PPLife: APLICATIVO INFORMATIVO PARA A GESTÃO DO CUIDADO E CONTROLE DAS DOENÇAS INFECTOCONTAGIOSAS NAS INSTITUIÇÕES PENAIS – Objetive: Develop an App for smartphones that can provide reliable information on TB, HIV, syphilis, hepatitis B and hepatitis C, as well as diagnostic flowcharts and the calculation of operational indicators. Methodology: The application was developed based on the Design Science Research (DSR) methodology, which involves twelve steps: identification of the problem, awareness of the problem, systematic review, identification of artifacts, configuration of classes of problems, proposition of artifacts to solve the specific problem, artifact design, artifact development, artifact evaluation, learning explanations, conclusion, generalization to a class of problems, and communication of results. Result: The functional evaluation of the App showed good functionality, good reliability, good usability, and good efficiency for professionals in the prison system. Conclusion: The PPLife App was developed to provide useful and reliable information for workers in the prison system, regarding the control of infectious and contagious diseases, based on the rigorous DSR methodology. Final Considerations: The work's intersectoral and interinstitutional proposal enabled actions and strategies that contributed to the state management of prison health, especially in the control of infectious and contagious diseases. The monitoring and evaluation of infectious and contagious diseases, with the definition of indicators and targets, helps health professionals who work in the prison system in the management of cases and health care directed to the PDL. EPS, developed online, democratized access to knowledge, allowed the discussion of relevant topics by health macro- regions of the state and the 1st Competi-TB resulted in TB control actions in penal institutions, demonstrating, in practice, the possibility and necessity of its realization. The PPlife App is a technical product, the result of this doctoral thesis, a legacy of the work carried out and presented as a work and management tool, including theoretical content related to tuberculosis, syphilis, HIV, hepatitis B and Hepatitis C and the calculation of specific indicators for PPL.