ADVANCEMENT OF PULMONARY TUBERCULOSIS IN THE HOMELESS POPULATION IN THE BRAZILIAN NORTHEAST: AN ECOLOGICAL STUDY

Abstract

Tuberculosis (TB) is a disease with strong social determination, with a risk of illness 56 times higher in the Homeless Population (HP). In Northeast Brazil, the scenario is worsened by structural vulnerabilities and the impacts of the COVID-19 pandemic. Given this context, this study aimed to analyze the progress of pulmonary TB among the HP in the Northeast between 2014 and 2024. This is an ecological, retrospective, and quantitative study, using data from SINAN/DATASUS. Variables related to notified records were analyzed, including sociodemographic data, diagnostic tests, and the annual percentage change in notifications. A total of 6,937 cases of pulmonary TB were recorded. The predominant profile was men (approximately 77%), self-declared Black or Pardo (approximately 85%), of working age (20-59 years), and with low education levels. The first sputum smear microscopy was positive in more than 50% of cases, but sputum culture was underutilized (not performed in >67%). Temporal analysis revealed alarming growth: new cases increased by 675.4%, while re-entries after treatment default jumped by 1,111.1%, numerically surpassing new cases in the 2023-2024 biennium. In conclusion, pulmonary TB among the HP in the Northeast shows a sharp upward trend and flaws in the diagnostic pathway. The critical increase in re-entries after abandonment highlights the difficulty of therapeutic adherence and the need for intersectoral public policies that consider the specificities and extreme vulnerability of this population to mitigate morbidity and mortality.