A crise mundial causada pela pandemia da COVID-19 afetou o mundo de diversas maneiras, principalmente os sistemas de saúde, em especial nos países menos desenvolvidos. Nesse sentido, estudos tem mostrado diferenças na percepção dos serviços de saúde e na maneira como a pandemia afetou as populações com base no perfil sociodemográfico e no ambiente em que os indivíduos estão inseridos. Este trabalho teve como objetivo avaliar o acesso e o nível de confiança aos serviços de saúde da população de assentados dos municípios de Juara e Sinop em Mato Grosso, Brasil. Foram entrevistados 101 moradores de assentamentos aplicando o questionário Termômetro Social COVID-19. Os dados analisados utilizando os softwares SPSS versão 22, foram realizadas análises descritivas e qui-quadrado, para comparar a confiança nos serviços de saúde entre os municípios. Observou-se que a maioria da população de assentados destas cidades faz o uso do Sistema Único de Saúde. Além disso, a maioria demostrou confiar mais nos serviços de Atenção Primária à Saúde em detrimento aos demais serviços. Ainda, quando comparado o nível de confiança no sistema de saúde entre os municípios de Sinop e Juara, os moradores de assentamento em Juara confiam nos serviços de saúde, enquanto os de Sinop desconfiam.

OBJECTIVE:To analyze the recrudescence of tuberculosis in the state of São Paulo after the COVID-19 pandemic, identifying temporal trends and spatial clusters of the disease. METHODS:An ecological study of tuberculosis cases reported on TBWeb in all São Paulo municipalities between January 2015 and December 2023. Time decomposition techniques, interrupted time series analysis by month and spatial analysis by municipality (global Moran index and Getis-Ord Gi*) were applied to identify trends, abrupt changes associated with the pandemic and clusters of high incidence, mortality, and treatment outcomes. The pre-pandemic (01/2015 to 01/2020), pandemic (02/2020 to 04/2022), and post-pandemic (05/2022 to 12/2023) periods were analyzed separately. RESULTS:There was an upsurge in tuberculosis in the post-pandemic period, with a 21.2% increase in the number of municipalities with an incidence > 110 cases per 100,000 inhabitants. There was a progressive increase in the mortality trend of 0.0026 (95%CI: 0.0016 to 0.0035) deaths per 100,000 inhabitants per month after the pandemic. There was a gradual drop of 0.67% (95%CI: -1.099 to -0.246) per month in the proportion of people cured after the pandemic. High incidence clusters persisted in the Presidente Prudente region in all periods, and new clusters in Marília and Registro after the pandemic. Areas with high mortality rates persisted in the regions of Taubaté, Baixada Santista, Grande São Paulo, Registro, Sorocaba and Campinas in all periods. CONCLUSION:The recrudescence of tuberculosis in São Paulo in the post-pandemic context highlights the need for targeted strategies for early diagnosis, strengthening treatment and intensive monitoring in regions identified as clusters, especially those with vulnerable populations and structural challenges in health services.

RESUMO Objetivos: Analisar os fatores associados à frequência de resultados falso-negativos para o teste rápido molecular (TRM-TB) para o diagnóstico de tuberculose pulmonar no estado de São Paulo. Métodos: Estudo transversal, que utilizou casos de tuberculose pulmonar do estado de São Paulo notificados no sistema Sistema de Notificação e Acompanhamento dos Casos de Tuberculose (TB-WEB) entre 2014 e 2023. O resultado do TRM-TB foi comparado aos resultados da baciloscopia de escarro, cultura de escarro e teste de sensibilidade. Posteriormente, variáveis com p<0,05 nos testes estatísticos foram incluídas na regressão logística. Resultados: Aumento significativo no uso do TRM-TB ao longo dos anos, atingindo 76% dos casos em 2023. A análise da acurácia do teste revelou alta concordância com a cultura de escarro (82,6%) e o teste de sensibilidade (98,4%), embora tenha apresentado menor concordância com a baciloscopia (78,5%). A pesquisa identificou fatores associados a resultados falso-negativos no TRM-TB, como idade avançada, sexo feminino, presença de vírus da imunodeficiência humana (HIV), privação de liberdade e radiografia de tórax normal. A regressão logística confirmou que esses fatores aumentam a chance de resultados falso-negativos. Conclusão: O TRM-TB é uma ferramenta eficaz no diagnóstico da tuberculose pulmonar, mas a interpretação dos resultados deve considerar os fatores de risco específicos de cada paciente, especialmente em populações de alto risco. A pesquisa ressalta a importância de combinar o TRM-TB com outros métodos diagnósticos e avaliação clínica para garantir um diagnóstico preciso e tratamento adequado.

Objectives To analyse the completeness of the COVID-19 vaccination schedule and identify factors associated with vaccine uptake.Design Cross-sectional study.Setting Data were collected through face-to-face interviews conducted in all 26 Brazilian state capitals and the Federal District between 2022 and 2023, using a sequential sampling approach.Participants A total of 1392 individuals aged 18 years or older experiencing homelessness for at least 6 months were included.Primary and secondary outcome measures The primary outcome was the completeness of the COVID-19 vaccination schedule (complete vs incomplete), based on self-reported vaccination status. Secondary analyses examined sociodemographic, institutional and behavioural factors associated with vaccine uptake using binary logistic regression.Results Completion of the vaccination schedule was positively associated with receiving government aid (OR: 1.58; 95% CI 1.09 to 2.30), visits from street clinic health agents (OR: 3.19; 95% CI 1.95 to 5.36), prior COVID-19 diagnosis (OR: 5.77; 95% CI 3.17 to 11.15), support for mandatory vaccination (OR: 3.76; 95% CI 2.48 to 5.76), trust in vaccine efficacy (OR: 3.92; 95% CI 2.63 to 5.89), seeking information from community sources (OR: 1.91; 95% CI 1.01 to 3.88) and trust in federal authorities (OR: 1.57; 95% CI 1.06 to 2.31).Conclusions This study identified structural, social and individual factors associated with complete COVID-19 vaccination among people experiencing homelessness in Brazil. Although overall coverage was substantial, gaps in vaccination completeness persisted. Social support, healthcare outreach and trust in vaccines were associated with higher uptake, highlighting important barriers and facilitators to vaccination in socially vulnerable populations.

Resumo Objetivo Identificar aglomerados espaço-temporais de risco para casos e para óbitos por síndrome respiratória aguda grave (SRAG) causada pela covid-19 e caracterizar a distribuição espacial da cobertura vacinal entre crianças e adolescentes de 0-19 anos no Brasil. Métodos Estudo de análise espacial com dados secundários dos 5.570 municípios do Brasil. Foram considerados casos e óbitos por SRAG causados pela covid-19 em crianças e adolescentes de 0-19 anos notificados entre março de 2020 e dezembro de 2024 no Sistema de Informação da Vigilância Epidemiológica da Gripe. Foram analisados registros de vacinação entre janeiro de 2021 e dezembro de 2024. As taxas de cobertura vacinal foram calculadas por faixa etária e esquema vacinal. Os aglomerados espaço-temporais foram identificados pela técnica de varredura espacial. Resultados Foram registrados 74.470 casos e 3.749 óbitos na população de 0-19 anos. Identificaram-se aglomerados significativos de alto e de baixo risco, inclusive um de proteção para casos entre 0-19 anos (risco relativo [RR] 0,28; intervalos de confiança de 95% [IC95%] 0,27; 0,29) e outro de alto risco para óbitos nas regiões Norte, Nordeste e Centro-Oeste (RR 3,28; IC95% 3,00; 3,59). A vacinação primária alcançou elevada cobertura (85,2%), especialmente entre adolescentes de 15-19 anos (96,8%), e a dose de reforço permaneceu insuficiente (23,1%). A distribuição espacial evidenciou heterogeneidade, com menores coberturas vacinais no Norte e no Centro-Oeste. Conclusão Evidenciaram-se desigualdades espaço-temporais nos casos e nos óbitos por SRAG por covid-19 entre crianças e adolescentes, com aglomerados de risco e de heterogeneidade na cobertura vacinal, marcada por alta cobertura primária e por baixo reforço, especialmente no Norte e no Centro-Oeste.

Objetivo: analisar a distribuição espacial e o comportamento da tuberculose droga resistente no estado do Paraná, sob a perspectiva da incidência, da tendência temporal e sua relação com a região de fronteira do Brasil com outros países. Método: estudo ecológico, com análise espacial e temporal. Os dados foram coletados do Sistema de Informação de Tratamentos Especiais de Tuberculose e do Departamento de Informática do Sistema Único de Saúde. Foram incluídos os casos novos de tuberculose drogarresistente notificados no Paraná entre 2013 e 2020. Calculou-se a taxa de incidência e, posteriormente, utilizou-se a técnica de Estatística de Varredura Espacial e Espaço-temporal, seguida da análise de regressão temporal por meio da técnica Joinpoint. Resultados: foram notificados 515 casos de tuberculose drogarresistente no período estudado, com incidência de 15,76 casos/100 mil habitantes, identificando áreas de risco nas regiões Norte, Leste e Oeste do estado. A análise espaço-temporal identificou, na região Leste, um cluster com maior risco relativo (RR = 9,89) para o período de 2013 a 2016. Na tendência temporal, verificou-se que os casos de tuberculose drogarresistente diminuíram a partir de 2020. Conclusão: é interessante observar que, neste estudo, a tuberculose drogarresistente não demonstrou ter uma relação direta com esta região. Porém, a análise espacial da incidência e a identificação de clusters com altas taxas e riscos proporcionaram uma visão dos casos no estado. Diante do cenário, é fundamental investir em estratégias de prevenção, diagnóstico e tratamento para reduzir a carga do bacilo resistente e alcançar as metas propostas para a erradicação da tuberculose.

Abstract Background Rifampicin-resistant tuberculosis (RR-TB) remains a major public health challenge in TB-endemic regions. While social determinants of health, including socioeconomic status, affect infectious disease outcomes, their impact on RR-TB remains poorly understood. This study evaluated the relationship between educational attainment, social disadvantage, and RR-TB outcomes. Methods We conducted a retrospective cohort study using data from four CAPRISA RR-TB clinical trials. Social vulnerability was measured using an exploratory Social Disadvantage Score (SDS) that incorporated education, employment, and incarceration. We used a latent class analysis (LCA) to identify classes with shared social vulnerability indicators. Associations with treatment outcomes were assessed using separate Cox regression models, with the exploratory SDS, its component indicators, and derived latent classes as predictors. Results Education was not independently associated with unfavourable treatment outcomes (aHR=1.39, 95% CI: 0.96–1.99, p=0.077), whereas a history of incarceration doubled the hazard (aHR=2.05, 95% CI: 1.33–3.16, p<0.001). Restricting subsequent models to the sub-cohort with collected employment data, unemployment increased the hazard of unfavourable outcomes (aHR=1.84, 95% CI: 1.20–2.82, p=0.005). Using the same sub-cohort, increasing cumulative social disadvantage showed a strong dose–response relationship, with a fivefold higher hazard for three disadvantages (aHR=5.85, 95% CI: 2.73–12.56, p < 0.001). LCA revealed that Class 2 (moderate socioeconomic advantage) had a significantly higher hazard of unfavourable outcomes (aHR=1.82, 95% CI: 1.19–2.79, p=0.006). Conclusion Cumulative social risk score was associated with unfavourable RR-TB outcomes. These findings support further evaluation of targeted support for disadvantaged populations to enhance RR-TB treatment success.

BackgroundThe COVID-19 pandemic amplified digital divides in Brazil, restricting vulnerable groups’ online access to health information and preventive guidance, with limited intersectional analyses of these inequities. ObjectiveThis study aimed to investigate inequalities in digital exclusion and access to online COVID-19 information among people experiencing homelessness and residents of urban communities in Brazil by using an intersectional multilevel analysis. MethodsA cross-sectional study (2021-2023) involving 2652 participants (n=1353, 51% experiencing homelessness and n=1299, 49% from urban communities across 26 state capitals) was conducted using the adapted COVID-19 Social Thermometer questionnaire administered via face-to-face interviews. Multilevel analysis of individual heterogeneity and discriminatory accuracy examined 115 intersectional strata (gender, race and ethnicity, schooling, income, and Brazilian Unified Health System use) with online COVID-19 information seeking as the binary outcome; multilevel logistic models estimated additive effects and between-strata variance. ResultsMost participants were men (1600/2652, 60.3%), self-identified as Black or Brown individuals (1942/2652, 73.2%), and were Unified Health System users (2433/2652, 91.7%) without private insurance (2469/2652, 93.1%). Over one-third (905/2652, 34.1%) had no formal schooling; 62.4% (1655/2652) reported low income. A total of 39.2% (1040/2652) sought online COVID-19 information. Being a woman (odds ratio [OR] 1.49, 95% CI 1.13-1.97), higher schooling (OR 1.78-5.59, 95% CI 3.52-8.88), and higher income (OR 2.37-4.54, 95% CI 2.59-7.93) showed a stronger association with online COVID-19 information seeking; public health system use was not associated with the outcome (OR 0.92, 95% CI 0.64-1.33). Predicted probabilities ranged between 14% and 85% across 115 strata, with the lowest among Black or Brown men (no schooling or low income) and the highest among women and higher schooling or income. The intersectional analysis (n=2405) null model showed 24% between-strata variance; the full additive model reduced it to 1% (proportional change in variance=97%). ConclusionsIntersectional analysis reveals structural informational exclusion driven by additive disadvantages in schooling, income, and gender among participants, calling for digital inclusion policies, critical health literacy programs, and equitable multichannel communication strategies to address persistent COVID-19 information seeking disparities.

ObjectivesTo identify surveillance and care actions implemented for tuberculosis control in the country, as well as to analyze factors that hinder or facilitate their implementation.MethodsThis scoping review followed the methodology recommended by the Joanna Briggs Institute (JBI) Manual for Scoping Reviews and the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The protocol was registered in the Open Science Framework (OSF). The review question was formulated based on the PCC acronym, and searches were conducted in PubMed, Embase, LILACS, Web of Science, Scopus, and Google Scholar.ResultsOf the 564 records identified, 13 studies were included, encompassing 24,652 participants, including adults and children. Regarding prevention, BCG vaccination achieved approximately 90% coverage among children under 5 years of age. Diagnostic approaches included clinical evaluation, chest radiography, and laboratory tests (AFB smear microscopy/GeneXpert), while major challenges included shortages of supplies (reported in 100% of the studies) and underreporting.ConclusionUpdating guidelines, strengthening professional training, and expanding diagnostic and treatment services are priority measures to consolidate tuberculosis control in the country.

A pandemia de COVID-19 registrou inúmeros casos e óbitos desde seu início. A doença inicialmente afetou as classes sociais mais altas, mas se disseminou rapidamente entre as populações vulneráveis, com maior impacto em áreas com precário saneamento básico e acesso aos serviços de saúde. Este trabalho teve como objetivo avaliar a autopercepção de risco relacionada à COVID-19 nas pessoas assentadas e suas associações, e verificar a adesão às medidas de proteção adotadas por essa população para mitigar os riscos de acometimento pela COVID-19, nos municípios de Sinop e Juara em Mato Grosso. Foram entrevistados 101 moradores de assentamentos usando o instrumento Termômetro Social COVID-19. Os dados foram tabulados em planilhas do software Microsoft Office Excel 2010 e importados para análise utilizando o software SPSS versão 22, para análises descritivas e software RStudio versão 4.1.1, para regressão logística binária. Foi possível observar que a população entrevistada teve boa adesão as medidas protetivas, incluindo a vacinação. Também, foi possível observar quais parcelas dessa população tem a autopercepção de risco elevado em desenvolver doença grave em caso de ser acometido por COVID-19, onde a maioria das características estão relacionadas com questões de vulnerabilidade social.

ABSTRACT Objective: To analyze the factors associated with the frequency of false negative results for the RMT-TB test for the diagnosis of pulmonary tuberculosis in the state of São Paulo. Methods: Cross-sectional study using pulmonary tuberculosis cases from the state of São Paulo reported in the TB-WEB system between 2014 and 2023. RMT-TB results were compared with sputum smear microscopy, sputum culture, and sensitivity testing. Subsequently, variables with p<0.05 in the statistical tests were included in the logistic regression. Results: There was a significant increase in the use of RMT-TB over the years, reaching 76% of cases in 2023. Analysis of the test accuracy revealed high agreement with sputum culture (82.6%) and the sensitivity test (98.4%), although it showed lower agreement with sputum smear microscopy (78.5%). The study identified factors associated with false-negative results on the RMT-TB, such as advanced age, female sex, HIV status, imprisoned, and a normal chest X-ray. Logistic regression confirmed that these factors increase the likelihood of false-negative results. Conclusion: The RMT-TB is an effective tool for diagnosing pulmonary tuberculosis, but the interpretation of results must consider each patient’s specific risk factors, especially in high-risk populations. The study highlights the importance of combining the RMT-TB with other diagnostic methods and clinical evaluation to ensure accurate diagnosis and appropriate treatment.

Background:Tuberculosis remains a major cause of preventable mortality in Brazil, marked by pronounced social and territorial inequalities. Evidence remains limited on how socioeconomic conditions and health system characteristics are associated with tuberculosis mortality across age groups in high-burden settings such as São Paulo state. This study aimed to examine the spatial and temporal associations of these factors with tuberculosis mortality across municipalities in the State of São Paulo, Brazil. Methods:We conducted a population-based ecological study in São Paulo, Brazil. All TB deaths reported to the Mortality Information System from 2020 to 2024 were included. Socioeconomic, demographic and health system factors were selected based on a conceptual framework. Variables associated with TB mortality were assessed using Generalized Additive Models for Location, Scale, and Shape, with spatial smoothing. Findings:The analysis included 38,700 municipality-month observations. In the final spatial GAMLSS model, proportions of household crowding (>2 residents/bedroom) and elderly population (>59 years) were associated with 3.25% and 5.92% increases in expected TB mortality for each one percentage-point increase, respectively. In contrast, each one percentage-point increase in primary health care coverage was associated with a 0.30% decrease in expected TB mortality. The fitted spatial effect indicated higher expected TB mortality along coastal and central regions, and lower expected mortality in the northwestern region. Interpretation:Tuberculosis mortality in São Paulo is shaped by persistent socioeconomic and territorial inequalities, with distinct patterns across age groups. These findings highlight the need for strategies that address structural vulnerability and strengthen primary health care to reduce avoidable tuberculosis-related deaths. Funding:This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil and São Paulo State Research Foundation (FAPESP).

Abstract Objective To identify space-time risk clusters for cases and deaths from severe acute respiratory syndrome (SARS) caused by COVID-19 and to characterize the spatial distribution of vaccination coverage among children and adolescents aged 0–19 years in Brazil. Methods Spatial analysis study using secondary data from the 5,570 municipalities in Brazil. Cases and deaths from SARS caused by COVID-19 among children and adolescents aged 0–19 years reported between March 2020 and December 2024 in the Influenza Epidemiological Surveillance Information System (Sistema de Informação da Vigilância Epidemiológica da Gripe, SIVEP-Gripe) were included. Vaccination records from January 2021 to December 2024 were analyzed. Vaccination coverage rates were calculated by age group and vaccination schedule. Space-time clusters were identified using the spatial scan technique. Results A total of 74,470 cases and 3,749 deaths were recorded in the population aged 0–19 years. Significant clusters of high and low risk were identified, including one protective cluster for cases among individuals aged 0–19 years (relative risk [RR] 0.28; 95% confidence interval [95%CI] 0.27; 0.29) and another high-risk cluster for deaths in the North, Northeast, and Central-West regions (RR 3.28; 95%CI 3.00; 3.59). Primary vaccination reached high coverage (85.2%), especially among adolescents aged 15–19 years (96.8%), whereas booster dose coverage remained insufficient (23.1%). The spatial distribution showed heterogeneity, with lower vaccination coverage in the North and Central-West regions. Conclusion Space-time inequalities were observed in cases and deaths from severe acute respiratory syndrome (SARS) caused by COVID-19 among children and adolescents, with risk clusters and heterogeneity in vaccination coverage, characterized by high primary coverage and low booster coverage, especially in the North and Central-West regions..

Historically, tuberculosis has been conceptualized in a binary manner as either tuberculosis infection or tuberculosis disease. However, emerging evidence supports the existence of a tuberculosis spectrum, which necessitates rethinking systematic screening approaches for early diagnosis. These spectrums include tuberculosis infection, incipient tuberculosis, and asymptomatic tuberculosis, all of which may precede the progression to tuberculosis symptomatic disease. Therefore, asymptomatic tuberculosis appears to be an important challenge to disease elimination, particularly among migrants and refugees, demanding early diagnosis and treatment to interrupt community transmission and prevent avoidable deaths. It may be important to consider adopting an active screening strategy that is sensitive to asymptomatic individuals.

ObjectivesTo critically analyze, through a systematic documentary approach, the health and social policies implemented in Brazil to address tuberculosis during and after the COVID-19 pandemic, identifying advances, challenges, and gaps in federal coordination.MethodsQualitative documentary study of 438 normative documents published between 2020 and 2024, including laws, decrees, ordinances, and resolutions at the federal, state, and municipal levels. Thematic content analysis was applied to examine the empirical material.ResultsSix thematic categories emerged: financial aspects and resources; management and policies; social support; social context and community participation; development and innovation; and health care strategies. The analysis revealed lack of coordination among governmental spheres, regional inequalities, and gaps in innovation and management.ConclusionAddressing TB in the post-pandemic context requires federal integration, strengthened evidence-based policies, and investments in innovation, offering relevant lessons for countries with similar socioeconomic contexts.

The COVID-19 pandemic has intensified existing health inequities, particularly among international migrants, who often face barriers to healthcare access and vaccination. In Brazil, where the Unified Health System (SUS) provides universal coverage, little is known about COVID-19 vaccination coverage and healthcare utilization among international migrants. This study aimed to analyze COVID-19 vaccination coverage, associated factors, and the use of SUS services among international migrants in Brazil during the pandemic. A cross-sectional study was conducted through face-to-face interviews with 374 international migrants residing in Brazil for at least six months. Participants were recruited between May 2022 and October 2023 through community networks and organizations in 26 of Brazil’s 27 federative units. COVID-19 vaccines were provided exclusively through SUS infrastructure and facilities. Data were collected via face-to-face interviews using a culturally adapted questionnaire covering sociodemographic characteristics, vaccination status, healthcare utilization, and trust in health services. Descriptive statistics and binary logistic regression were used to identify factors associated with COVID-19 vaccination and SUS utilization. Analyses were conducted using RStudio software. Among participants, 82.4

ABSTRACT Tuberculosis (TB) is among the oldest and deadliest infectious diseases, particularly when associated with human immunodeficiency virus (HIV) and antimicrobial resistance. Despite the progress in prevention, diagnosis, and treatment, global elimination remains elusive and is driven largely by socioeconomic inequalities and systemic challenges. Although scientific research is a cornerstone of the WHO End TB Strategy, it has been chronically underfunded and undervalued in Brazil’s health agenda. One critical consequence is the weakening of pipelines for future TB research. Funding shortages, lack of incentives, and the shifting attention toward s other emerging diseases have made it increasingly difficult to recruit and retain scientists in the field of TB. This opinion paper aimed to explore the historical role of Brazilian science in advancing TB control while addressing the emerging crisis of renewing the country’s TB scientific workforce. We conducted a narrative synthesis of the available literature, reviewing impactful peer-reviewed articles produced by Brazilian scientists in the field of TB science, alongside official documents from the Brazilian Ministry of Health. This was complemented by a bibliometric analysis of the output of TB-related PhD theses (2016-2024) and PubMed-indexed publications (2001-2024) from Brazilian institutions. Finally, we discuss the systemic barriers affecting early career researchers and outline strategies for revitalizing interest and sustaining scientific progress. These include targeted TB research funds through public-private partnerships, structured mentorship programs, and competitive early career fellowships. Such interventions are essential for reversing the current decline in TB research engagement and ensuring that Brazil continues to contribute to global TB elimination efforts while preserving its scientific legacy.