Revista de saude publica最新文献

{"title":"Prices paid for primary health care medicines by Brazilian municipalities.","authors":"Wendell Rodrigues Oliveira da Silva, Ivanessa Thaiane do Nascimento Cavalcanti, José Roberto Peters, Luis Eduardo Maciel Dos Santos Ferreira, Rafael Santos Santana, Silvana Nair Leite","doi":"10.11606/s1518-8787.2025059006964","DOIUrl":"10.11606/s1518-8787.2025059006964","url":null,"abstract":"<p><strong>Objective: </strong>The study analyzes the prices paid by Brazilian municipalities for medicines in 2016, 2018, and 2020, comparing municipal human development index, size, region, and purchase modality.</p><p><strong>Methods: </strong>Economic Ratio indicator, adapted from that proposed for international analyses by the World Health Organization, was used and analyses were performed using data provided by municipalities to the National Database of Pharmaceutical Assistance Actions and Services.</p><p><strong>Results: </strong>The study reveals that the most socially and economically vulnerable municipalities pay more for these medicines, especially in the North and Northeast regions, which can compromise access to and the efficiency of the Unified Health System. Moreover, the article shows that municipalities that purchased in association tend to pay lower prices, suggesting that consortia may be a strategy to mitigate price inequalities.</p><p><strong>Conclusions: </strong>Based on the results obtained, we propose the adoption of regulatory, economic, and negotiation strategies to reduce these differences and ensure a more equitable distribution of medicines in Brazil.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e45"},"PeriodicalIF":2.1,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purchase of food from the new staple food basket in low-income Brazilian households.","authors":"Marcos Anderson Lucas da Silva, Lucas Braga Rodrigues, Samuel Almeida Brito, Luisa Gazola Lage, Maria Laura da Costa Louzada","doi":"10.11606/s1518-8787.2025059006780","DOIUrl":"10.11606/s1518-8787.2025059006780","url":null,"abstract":"<p><strong>Objective: </strong>To describe the purchase of foods included in the new staple food basket by low-income households in Brazil, from 2017 to 2018.</p><p><strong>Methods: </strong>Data on household food purchases were obtained from the 2017-2018 Household Budget Survey, conducted by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Data from 13,706 low-income households (< ½ minimum wage per capita) were analyzed. Foods were identified based on an ordinance issued by the Ministry of Social Development and Fight Against Hunger, which specifies the composition of the new staple food basket. Estimates were expressed as a percentage of caloric intake.</p><p><strong>Results: </strong>Foods introduced into the new staple food basket accounted for 84.1% of the total calories purchased by low-income households in Brazil, from 2017 to 2018, with significant participation in rural areas (88.0%) and in the North (88.2%) and Northeast (85.9%) regions. Among food groups, cereals (33.5%), sugars and oils/fats (21.3%), and meats and eggs (11.6%) presented the highest contributions. Rice, corn, and other grains contributed 19.7%, whereas beans accounted for 4.7% of calories. Poultry meat and beef were the most purchased foods in the meat and egg group, representing 5.0% and 4.0% of calories, respectively. Fruits contributed 1.9% and vegetables 0.7% of calories. We observed no major differences in food purchase regarding the race/skin color of the head of the household.</p><p><strong>Conclusion: </strong>Analysis shows that in the 2017-2018 period, the foods included in the new staple food basket became the basis of low-income households' diet, reinforcing the cultural viability of its implementation.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e43"},"PeriodicalIF":2.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood perception and depressive symptoms: the ELSI-Brasil national study, 2015-2016.","authors":"Pablo Cardozo Roccon, Amanda Cristina de Souza Andrade, Débora Moraes Coelho, Bruno de Souza Moreira, Luciana de Souza Braga, Maria Fernanda Lima-Costa, Waleska Teixeira Caiaffa","doi":"10.11606/s1518-8787.2025059006948","DOIUrl":"10.11606/s1518-8787.2025059006948","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between depressive symptoms and neighborhood perception among older adults living in urban areas.</p><p><strong>Methods: </strong>This cross-sectional study included 7,115 individuals (≥ 50 years) from the baseline (2015-2016) of the Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brazil - Brazilian Longitudinal Study of Aging) who lived in urban areas and had self-reported responses (no proxy respondents), with complete data on the outcome. The outcome was assessed using the 8-item Center for Epidemiologic Studies-Depression Scale (CES-D-8) (cutoff ≥ 4), and the exposure variable was neighborhood perception related to participants' area of residence. Univariable and multivariable Poisson regression analyses were performed, with each exposure variable adjusted for sociodemographic characteristics and health conditions.</p><p><strong>Results: </strong>The prevalence of depressive symptoms was 34.9%, being 43.8% among women and 24.5% among men. In the multivariable analysis, urban mobility issues, noise pollution, physical disorder, violence, lack of neighborhood pleasantness, low social cohesion, and perceived insecurity were significantly associated with a higher prevalence of depressive symptoms in the overall sample and among women. Among men, all variables except perceived insecurity were also significantly associated with higher prevalence of depressive symptoms.</p><p><strong>Conclusion: </strong>The findings highlight the importance of intersectoral action across health, urban mobility, public safety, and urban planning policies to promote mental health among older adults living in urban areas.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e42"},"PeriodicalIF":2.4,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145725409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissatisfaction with SUS pharmaceutical services and nonadherence to medication use.","authors":"Poliana Vieira da Silva Menolli, Edmarlon Girotto","doi":"10.11606/s1518-8787.2025059006463","DOIUrl":"10.11606/s1518-8787.2025059006463","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the association between user dissatisfaction with the pharmaceutical services provided by the Brazilian Unified Health System (SUS) and nonadherence to medication use by patients with chronic non-communicable diseases.</p><p><strong>Methods: </strong>A cross-sectional study with data from the service evaluation component of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos in Brazil, conducted from July to December 2014. In-person interviews were analyzed with SUS users aged 18 or over who had used medications for hypertension, diabetes, and dyslipidemia and had visited SUS pharmacies in the three months prior to the survey. The dependent variable was medication nonadherence, assessed through three measures: nonadherence due to lack of medication, nonadherence in the past seven days and declared nonadherence. The independent variable was dissatisfaction with the dimensions of pharmaceutical services (timeliness, availability, and accommodation), measured using item response theory. Logistic regression was performed to calculate crude and adjusted odds ratios (OR).</p><p><strong>Results: </strong>A total of 2,448 users were evaluated. Nonadherence due to lack of medication was 31.6%; in the past seven days was 11.5%; and declared nonadherence 13.0%. Lack of access and forgetfulness were the main reasons for nonadherence in the past seven days. In the adjusted analysis, dissatisfaction with the \"timeliness\" dimension was associated with nonadherence in the past seven days (OR = 1.489; 95%CI: 1.023-2.168) and the \"accommodation\" dimension was associated with declared nonadherence (OR = 3.132; 95%CI: 2.266-4.329).</p><p><strong>Conclusion: </strong>Dissatisfied users were more likely to be nonadherent to medication use across all service dimensions, and dissatisfaction with the availability and accommodation of pharmaceutical services was associated with nonadherence.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e36"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yellow fever mortality in Brazil: an age-period-cohort study.","authors":"Lucas Casagrande Passoni Lopes","doi":"10.11606/s1518-8787.2025059006721","DOIUrl":"10.11606/s1518-8787.2025059006721","url":null,"abstract":"<p><strong>Objective: </strong>To analyze yellow fever mortality trends in Brazil, focusing on sexes differences and using an age-period-cohort model.</p><p><strong>Methods: </strong>This ecological study analyzed yellow fever mortality data in Brazil from 1980 to 2019 sourced from Datasus. Population estimates were retrieved from the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Mortality data, including age, year of death, and cause (ICD-9: 060; ICD-10: A95), were analyzed using an age period cohort model. A Poisson distribution was assumed for mortality counts, and analyses were conducted using Holford's method and its adaptations on R.</p><p><strong>Results: </strong>The results show that the incidence rate peaked at younger ages, such as 30 years (0.010/100,000 individuals, 95%CI: 0.008/100,000 to 0.013/100,000), followed by a gradual declining trend with increasing age, reaching 0.007/100,000 individuals (95%CI: 0.005/100,000 to 0.010/100,000) at 50 years onward. Regarding period, a substantial increase in the adjusted hazard ratio occurred over time, especially in 2015 (13.923 [95%CI: 11.095 to 17.471]), suggesting a significant elevation when compared with previous periods. Cohort analysis showed a trend of increasing risk until 1960 (RR = 1.000), followed by a marked reduction for more recent cohorts, such as 2010: RR = 0.056 (95%CI: 0.028 to 0.112). Vaccination analysis showed alternating periods of significant increases and decreases in vaccination rates.</p><p><strong>Conclusions: </strong>Younger individuals showed higher mortality rates, with a gradual decline with advancing age. Period effects highlighted a pronounced resurgence in recent years, particularly during the 2015 epidemic, underscoring the influence of temporal factors such as outbreaks and vaccination campaigns. Cohort analysis showed a progressive decline in mortality risk among more recent birth cohorts, likely reflecting the impact of expanded immunization programs and improved public health measures. The proposed yellow fever vaccination trends in Brazil may explain some of the observed patterns.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e31"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival of neoadjuvant versus adjuvant systemic treatment for breast cancer in Brazil.","authors":"Carolina Zampirolli Dias, Carolina Campos Vieira de Sousa, Thais Piazza, Ilka Afonso Reis, Augusto Afonso Guerra Junior, Mariangela Leal Cherchiglia","doi":"10.11606/s1518-8787.2025059006671","DOIUrl":"10.11606/s1518-8787.2025059006671","url":null,"abstract":"<p><strong>Objective: </strong>Compare the overall survival of women with non-metastatic breast cancer who received neoadjuvant systemic therapy followed by surgery versus those who underwent surgery followed by adjuvant systemic therapy.</p><p><strong>Methods: </strong>A nationwide retrospective cohort study was conducted using real-world data from 2008 to 2015 available on the Brazilian Unified Health System (SUS). Women aged ≥ 18 years with breast cancer undergoing surgery or neoadjuvant systemic therapy as their first treatment between 2008 and 2010 were included. Cohorts were matched using propensity score matching in a 1:1 ratio and assessed 5-year overall survival using Kaplan-Meier, compared by log-rank test and hazard ratios (HR) using Cox proportional HR model.</p><p><strong>Results: </strong>A total of 23,331 women began treatment for breast cancer in SUS with neoadjuvant systemic therapy (n = 6,040) and surgery (n = 17,291). In the matched cohorts (n = 6,040 in both groups), more deaths occurred among those who received neoadjuvant systemic therapy compared with surgery as first treatment (37.3% and 19.6%, respectively; p < 0.001). Overall survival after five years was 0.641 in neoadjuvant systemic therapy and 0.816 in the surgery group (p < 0.001). For both groups, older patients (≥ 70 years) living in northern and midwestern Brazil, in municipalities with low and medium HDI, and self-declared as Black presented the lowest overall survival probabilities. Use of hormone therapy after surgery and conservative surgery instead of mastectomy were associated with higher survival. HR was 5.13 (95%CI: 2.95-8.88) in stage I, 1.57 (95%CI: 1.27-1.95) in stage II, and 1.38 (95%CI: 1.26-1.50) in stage III.</p><p><strong>Conclusion: </strong>Women who underwent surgery as first treatment had a significantly higher 5-year overall survival compared with those who received neoadjuvant systemic therapy. Socioeconomic and demographic factors influenced survival outcomes.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e38"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locomotion difficulty and need for home care: a cross-sectional study.","authors":"Rogério da Silva Linhares, Elaine Thumé, Maria Laura Vidal Carrett, Everton José Fantinel, Maria Aurora Dropa Chrestani Cesar, Elaine Tomasi","doi":"10.11606/s1518-8787.2025059006939","DOIUrl":"10.11606/s1518-8787.2025059006939","url":null,"abstract":"<p><strong>Objective: </strong>To investigate home visits by physicians or nurses for consultations and procedures and associated factors in families with people with mobility difficulties and need for home care.</p><p><strong>Methods: </strong>A cross-sectional study was carried out with data from Ciclo III do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (Cycle III of the National Program for Access and Quality Improvement in Primary Care) from September 2017 to June 2018, interviewing over 140,000 users in 28,939 basic health units in 5,312 municipalities. This study analyzed home visits to individuals with mobility difficulties and the need for home care according to internal and external factors via a Poisson regression.</p><p><strong>Results: </strong>Of all primary healthcare service users, 7.8% stated that someone in their home had mobility difficulties and needed home care. About 70% received home visits. The highest prevalence of home visits, after adjusted analysis, occurred in the Brazilian Northeast. The greater the social vulnerability, the lower the prevalence of home visits in the case of mobility difficulties. Municipalities with 100% coverage from the family health strategy showed a higher prevalence of home visits than those with coverage below 50%.</p><p><strong>Conclusion: </strong>External factors, such as income and social vulnerability index (which have a greater relation with macrosocial determinants), continue to point toward inequalities in care; whereas internal factors, such as family health coverage, community health agent coverage in all micro-areas, and the possibility of receiving care without prior appointments indicated better results. This study reinforces the importance of public policies that encourage complete family health teams to provide comprehensive care to the population.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e35"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-COVID-19 syndrome and health-related quality of life after hospital discharge.","authors":"Roseany Patricia Silva Rocha, Amanda Cristina de Souza Andrade, Ana Paula Muraro","doi":"10.11606/s1518-8787.2025059006650","DOIUrl":"10.11606/s1518-8787.2025059006650","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the association between the presence of post-COVID-19 syndrome after six months and health-related quality of life 6 and 12 months after hospital discharge.</p><p><strong>Method: </strong>An ambidirectional cohort study was conducted with individuals discharged from three of the main hospitals in Cuiabá (in the state of Mato Grosso) between October 2021 and March 2022. After collecting data from medical records, individuals were interviewed via telephone 6 months (n = 189) and 12 months (n = 159) after hospital discharge, evaluating the presence of at least one persistent post-COVID-19 symptom at 6 months (post-COVID-19 syndrome) and health-related quality of life (EQ-5D-3L) at 6 and 12 months, as well as specific dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The association was assessed via Poisson regression with robust variance, adjusted for sociodemographic, health, and hospitalization characteristics.</p><p><strong>Results: </strong>Of the individuals assessed, 88.4% answered that they had COVID-19 symptoms in the interview after 6 months. At 6 and 12 months after hospital discharge, 55.0% and 74.2% of individuals, respectively, had some impairment in quality of life. In the multiple model, post-COVID-19 syndrome remained associated with having any quality of life issue (RR = 2.43; 95%CI: 1.06-5.57) and specifically with the anxiety/depression domain (RR = 2.74; 95%CI: 1.08-7.01) at 6 months after discharge. The association was no longer significant after 12 months.</p><p><strong>Conclusion: </strong>These results show the long-term negative repercussions of post-COVID-19 syndrome on cognitive, emotional, and physical functions, exposing the negative impact on the quality of life of those affected.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e34"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of the post-incorporation period of health technologies incorporated into the SUS, from 2012 to 2022.","authors":"Nayê Balzan Schneider, Ana Paula Beck Da Silva Etges, Carisi Anne Polanczyk","doi":"10.11606/s1518-8787.2025059006732","DOIUrl":"10.11606/s1518-8787.2025059006732","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the time elapsed in the post-incorporation process of procedures, orthoses, prostheses, and special materials, with a focus on compliance with the legal deadline of 180 days established for the provision of the technology.</p><p><strong>Methods: </strong>The analysis was conducted with procedures and orthoses, prostheses, and special materials recommended for incorporation by the National Commission for the Incorporation of Technologies from 2012 to 2022, and the technology identification code created in the Management System for the Table of Procedures, Medicines, Orthoses, Prostheses and Special Materials of the Brazilian Unified Health System, after incorporation. For the technologies identified, we calculated the median periods (Q1-Q3) of the days elapsed during the incorporation and post-incorporation periods. In addition, the proportion of technologies offered according to the legal deadline was verified, and the influence of variables on the post-incorporation period was analyzed.</p><p><strong>Results: </strong>Among 41 reports on procedures, orthoses, prostheses, and special selected materials, 79 technologies were analyzed. The coding period, defined as the benchmark for the supply of the technology, had a median of 204 (57-425) days. This period was longer than 180 days in 64% of the technologies assessed. Variables such as the organization group to which the technology belongs, indication of the need to adapt for implementation in the incorporation report, and delay in the evaluation period for incorporation seem to influence the period for providing the technology.</p><p><strong>Conclusions: </strong>The effective provision of technologies incorporated into the health system in Brazil has not occurred within the expected period of 180 days in most cases, which limits their accessibility to the population. Anticipating the need for adaptation before implementation, even during incorporation, seems to be a way of reducing the post-incorporation period.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e29"},"PeriodicalIF":2.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12666786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal trends and regional clusters of tuberculosis-HIV coinfection outcomes in Brazil.","authors":"Lucas Vinícius de Lima, Gabriel Pavinati, Yenny Lorena Valdivia-Rojas, José Nildo de Barros Silva Júnior, Ana Paula Sayuri Sato, Fredi Alexander Diaz-Quijano, Victor Santana Santos, Gabriela Tavares Magnabosco","doi":"10.11606/s1518-8787.2025059006736","DOIUrl":"10.11606/s1518-8787.2025059006736","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the temporal trends and regional clusters of tuberculosis treatment outcomes among people with HIV in Brazil, as well as their relationship with socioeconomic and programmatic indicators.</p><p><strong>Methods: </strong>Ecological study with data from people living with HIV who initiated and completed tuberculosis treatment from 2015 to 2021 in Brazil. We described the semiannual trends of cure, treatment interruption, and death rates in Brazilian states using joinpoint regression models. Cluster analyses stratified by three population sizes were conducted using the k-means method to identify clusters in 510 immediate geographic regions. Socioeconomic and programmatic indicators related to treatment interruption and death were included in multivariate negative binomial regression models.</p><p><strong>Results: </strong>A total of 54,362 tuberculosis treatments in people with HIV were analyzed, with cure rates of 55.51%, interruption rates of 23.33%, and death rates of 21.16% for the period. Nationally, cure rates remained stable, while treatment interruption increased by 2.54% per semester (ranging from 1.59% to 3.70%) and death increased by 9.31% (ranging from 7.41% to 17.24%). The states of Ceará and Amapá showed the worst trends for treatment interruption and death. Regions with greater income inequality, higher percentages of workers with only primary education, higher household density, and broader private health coverage had higher rates of treatment interruption and death. Conversely, regions with higher expected years of schooling and hospitalizations for primary care-sensitive conditions had lower probabilities of these outcomes.</p><p><strong>Conclusion: </strong>Nationally, despite stable cure rates, tuberculosis treatment interruption and death among people with HIV increased. Regional disparities in the relationship between socioeconomic and programmatic indicators and outcomes suggest inequities in access to and adherence to tuberculosis treatment across Brazil.</p>","PeriodicalId":21230,"journal":{"name":"Revista de saude publica","volume":"59 ","pages":"e39"},"PeriodicalIF":2.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}