BACKGROUND:
Tuberculosis (TB) elimination targets for 2030 depend on sustained health system performance and continuity of care1. Disruptions to health services, particularly during the COVID-19 pandemic, may have affected TB diagnosis, treatment, and follow-up2,3. São Paulo State, Brazil’s most populous state and the country’s highest TB burden setting, offers a relevant context to examine temporal changes in key TB outcomes. This study aimed to analyze trends in tuberculosis treatment outcomes and mortality in São Paulo State, Brazil, between 2015 and 2022.

METHODS:
An ecological time series study was conducted using TB case data from the Notifiable Diseases Information System (SINAN) and mortality data from official databases of the Brazilian Unified Health System. The analysis covered the period from 2015 to 2022 and focused on trends in cure, loss to follow-up, and tuberculosis-related deaths, with particular attention to the pandemic years (2020–2021). Prais–Winsten autoregression was applied to estimate monthly percent changes and classify temporal trends4.

RESULTS:
Loss to follow-up increased from 11.2% in 2015 to 13.3% in 2022, reaching a peak of 13.9% in 2021 and showing a significant increasing trend over time. Cure rates remained consistently below the national target of 85%, declining markedly in 2020 (66.4%) and presenting an overall decreasing trend throughout the study period. Tuberculosis-related deaths rose from 2.3% in 2015 to 3.2% in 2022, with the highest proportion observed in 2021. The most pronounced deteriorations in outcomes coincided with the COVID-19 pandemic period.

CONCLUSIONS:
The findings demonstrate unfavorable trends in tuberculosis treatment outcomes and mortality in São Paulo State between 2015 and 2022, particularly during the pandemic years. These results highlight the need to strengthen surveillance, care coordination, and patient-centered strategies to improve treatment outcomes and support progress toward tuberculosis elimination goals in high-burden settings.