Predictors of Unfavorable Tuberculosis Treatment Outcomes among Migrants and Refugees in Brazil: a Nationwide Retrospective Cohort Study
1
1. Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP), Ribeirão Preto, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A624
ABSTRACT
INTRODUCTION:
Tuberculosis (TB) is a public health problem that disproportionately affects populations, particularly vulnerable groups such as international migrants and refugees (IMR). In Brazil, IMR present a higher prevalence of tuberculosis infection as well as an increased risk of developing TB; however, evidence regarding treatment outcomes and their predictors in the national context remains scarce.
OBJECTIVE:
Identify predictors of unfavorable tuberculosis treatment outcomes among IMR in Brazil.
METHODS:
Retrospective cohort study was conducted using open-access data from compulsory TB notifications provided by the Department of Information and Informatics of the Brazilian Unified Health System, Ministry of Health. All TB cases recorded as migrants and diagnosed between 2014 and 2023 were included. Records with missing outcomes, “death from other causes,” “drug-resistant TB,” “change of diagnosis,” or “transfer” were excluded. For analytical purposes, outcomes were categorized as favorable (“cure”) or unfavorable (“primary loss-to-follow-up,” “loss to follow-up,” “treatment failure,” or “death due to TB”). Logistic regression analysis was performed using forward stepwise method, with univariate logistic regression and a p-value cutoff of 0.05 for inclusion in the multivariate model.
RESULTS:
5,284 cases were included, with an unfavorable outcome proportion of 26.5%. Ten predictors of unfavorable outcomes were identified, including sociodemographic factors such as mixed-race ethnicity (adjusted odds ratio [aOR]=1.54; 95%CI: 1.20–1.98), Indigenous ethnicity (aOR=1.77; 95%CI: 1.22–2.56), incarceration (aOR=0.47; 95%CI: 0.29–0.76), and homelessness (aOR=1.99; 95%CI: 1.42–2.78); clinical factors such as re-entry after loss to follow-up (aOR=3.28; 95%CI: 2.44–4.41), alcohol use (aOR=1.40; 95%CI: 1.02–1.92), drug use (aOR=2.49; 95%CI: 1.78–3.47), and combined pulmonary and extrapulmonary TB (aOR=2.26; 95%CI: 1.40–3.67); and institutional factors such as absence of HIV testing (aOR=1.99; 95%CI: 1.50–2.65) and lack of directly observed treatment (aOR=3.14; 95%CI: 2.57–3.83).
CONCLUSIONS:
IMR experience multiple vulnerabilities to unfavorable TB treatment outcomes, extending beyond social and individual dimensions to include operational inequities in access to health care.
Tuberculosis (TB) is a public health problem that disproportionately affects populations, particularly vulnerable groups such as international migrants and refugees (IMR). In Brazil, IMR present a higher prevalence of tuberculosis infection as well as an increased risk of developing TB; however, evidence regarding treatment outcomes and their predictors in the national context remains scarce.
OBJECTIVE:
Identify predictors of unfavorable tuberculosis treatment outcomes among IMR in Brazil.
METHODS:
Retrospective cohort study was conducted using open-access data from compulsory TB notifications provided by the Department of Information and Informatics of the Brazilian Unified Health System, Ministry of Health. All TB cases recorded as migrants and diagnosed between 2014 and 2023 were included. Records with missing outcomes, “death from other causes,” “drug-resistant TB,” “change of diagnosis,” or “transfer” were excluded. For analytical purposes, outcomes were categorized as favorable (“cure”) or unfavorable (“primary loss-to-follow-up,” “loss to follow-up,” “treatment failure,” or “death due to TB”). Logistic regression analysis was performed using forward stepwise method, with univariate logistic regression and a p-value cutoff of 0.05 for inclusion in the multivariate model.
RESULTS:
5,284 cases were included, with an unfavorable outcome proportion of 26.5%. Ten predictors of unfavorable outcomes were identified, including sociodemographic factors such as mixed-race ethnicity (adjusted odds ratio [aOR]=1.54; 95%CI: 1.20–1.98), Indigenous ethnicity (aOR=1.77; 95%CI: 1.22–2.56), incarceration (aOR=0.47; 95%CI: 0.29–0.76), and homelessness (aOR=1.99; 95%CI: 1.42–2.78); clinical factors such as re-entry after loss to follow-up (aOR=3.28; 95%CI: 2.44–4.41), alcohol use (aOR=1.40; 95%CI: 1.02–1.92), drug use (aOR=2.49; 95%CI: 1.78–3.47), and combined pulmonary and extrapulmonary TB (aOR=2.26; 95%CI: 1.40–3.67); and institutional factors such as absence of HIV testing (aOR=1.99; 95%CI: 1.50–2.65) and lack of directly observed treatment (aOR=3.14; 95%CI: 2.57–3.83).
CONCLUSIONS:
IMR experience multiple vulnerabilities to unfavorable TB treatment outcomes, extending beyond social and individual dimensions to include operational inequities in access to health care.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
