Trends and clusters of tuberculosis treatment interruption among people experiencing homelessness in Brazil: influence of individual, social and programmatic factors.

Abstract

Objective: To analyze temporal trends and state-level clusters of tuberculosis treatment interruption indicators among the homeless population in Brazil.

Methods: This is an ecological study, in which treatment interruption among homeless people with tuberculosis was assessed from 2015 to 2023. Joinpoint regression was used for trend analysis, stratified by sociodemographic and epidemiological variables. State clusters were identified by k-means clustering analysis, based on socioeconomic and programmatic indicators.

Results: Tuberculosis treatment interruption increased among: men (average quarterly percent change - AQPC=0.15; 95% confidence interval - 95%CI 0.04-0.29), individuals aged 40-59 years (AQPC=0.38; 95%CI 0.25-0.53), tobacco users (AQPC=0.72; 95%CI 0.61-0.82), beneficiaries of social programs (AQPC=4.59; 95%CI 3.69-6.02), those without directly observed treatment (AQPC=0.49; 95%CI 0.39-0.63), without HIV coinfection (AQPC=0.38; 95%CI 0.30-0.51), and in the North (AQPC=1.51; 95%CI 0.96-2.21) and Midwest (AQPC=0.83; 95%CI 0.17-1.59) regions. According to the cluster analysis, cluster A had the lowest treatment interruption rate, low AIDS incidence, and better programmatic indicators. Cluster B had high poverty and low level of education and income, but strong primary health care performance. Cluster C stood out for its higher human development, better social indicators, and lower inequality. Cluster D concentrated the worst outcomes: higher treatment interruption, greater inequality, higher AIDS incidence, and weaker primary health care.

Conclusion: Socioeconomic and programmatic inequalities were evident in access and attachment to tuberculosis treatment among people experiencing homelessness in Brazil.