Trend of epidemiological indicators and factors associated with tuberculosis treatment dropout and death among street people in Brazil: an ecological and cross-sectional study, 2014-2022.

Objective: To analyze the temporal trend of epidemiological indicators and factors associated with tuberculosis treatment dropout and death among street people.

Methods: This is a cross-sectional study on tuberculosis among street people in Brazil from 2014-2022, using data from the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação). We calculated cure, dropout, incidence and mortality indicators. The temporal trend of the indicators was estimated using Prais-Winsten regression, expressed via average percentage change (APC). Notification form variables were used to estimate factors associated with tuberculosis treatment dropout and death using logistic regression, resulting in odds ratios (OR) and 95% confidence intervals (95%CI).

Results: In all, 21,904 tuberculosis cases were reported. In Brazil as a whole, APC for cure was -5.8% (95%CI -7.9; -3.8), while in the Southeast region, APC for incidence was -6.2% (95%CI -8.9; -3.5) and for mortality it was -5.3% (95%CI -10.0; -0.4). Predictors of dropout were: absence of directly observed treatment (OR 3.92; 95%CI 3.65; 4.20), being 20-39 years old (OR 1.81; 95%CI 1.41; 2.33) and use of illicit drugs (OR 1.57; 95%CI 1.46; 1.69). Factors associated with death were: absence of directly observed treatment (OR 3.18; 95%CI 2.86; 3.54), being >60 years old (OR 3.14; 95%CI 2.14; 4.61) and use of illicit drugs (OR 1.18; 95%CI 1.05; 1.34).

Conclusion: The tuberculosis scenario in this population is worrying and its challenging context requires greater effort to achieve better screening and treatment, considering the multiple risk factors identified.