Dados do Trabalho

Título

The association between vulnerable populations and poor TB treatment outcome in Brazil: A Nationwide Study of Disease Registry Data

Introdução

Tuberculosis (TB) is the deadliest infectious diseases worldwide. A focus on socially vulnerable sub-populations at increased risk of TB is warranted to decrease the disease burden. We evaluated whether homelessness, pregnancy, incarceration, migration, and healthcare work (HCW) are risk factors for unfavorable anti-TB treatment (ATT) outcomes in Brazil through analysis of national disease registry data (SINAN). W evaluated the independent association of each type of vulnerability with death or loss to follow-up (LTFU).

Objetivo (s)

Characterize the profile of vulnerable populations with TB in Brazil; test if each vulnerability is a risk factor for ATT poor outcomes; and assess the likelihood of each vulnerability to death or LTFU

Material e Métodos

We conducted an observational study of TB cases >18 years-old reported to the SINAN between 2014-2021. Clinical and epidemiologic variables were compared between groups (non-vulnerability, homeless, prisoners, pregnant women, immigrants and HCW). Binomial and multinominal logistic regression models were employed to identify characteristics associated with a composite unfavorable TB outcome, specifically death or LTFU.

Resultados e Conclusão

Among 718,583 TB cases reported, 610,873 met inclusion criteria: 514,445 non-vulnerable, 20,186 homeless, 63,654 prisoners, 2,822 pregnant women, 2,819 immigrants, and 6,947 HCWs. TB case notification in the country was concentrated in the North and Southwest of Brazil in all sub-populations. Homelessness was the main risk factor for unfavorable ATT outcomes in the overall population, followed by living with HIV, drug and alcohol use. Pregnancy and immigration were also independent risk factors for unfavorable outcomes. Living with HIV was the main risk for death, whereas homelessness was the major risk factor for LTFU. Directly observed treatment (DOT), incarceration, and HCW were associated with favorable outcomes.
The study underscores the importance of prioritizing vulnerable populations in national tuberculosis control programs and highlights the need for individualized, person-centred care for target populations, especially for homeless people. The findings suggest that targeted Interventions to affect modifiable risk factors, DOT and social protection strategies can increase ATT success in Brazil, making it relevant for policy makers, health-care providers, and civil society representatives.

Palavras-chave

Tuberculosis; vulnerable populations; treatment outcome

Agradecimentos

National Institutes of Health