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Quantifying gaps in the tuberculosis care cascade in Brazil: A mathematical model study using national program data.

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Delays in tuberculosis (TB) diagnosis and treatment loss to follow-up significantly increase health losses in Brazil. Prioritizing faster diagnosis and better patient follow-up is crucial for reducing the TB disease burden.

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Area of Science:

  • Public Health
  • Epidemiology
  • Health Economics

Background:

  • Tuberculosis (TB) care in Brazil faces challenges including delayed diagnosis, ineffective treatments, and patient loss to follow-up.
  • These gaps lead to significant health losses and program costs for TB disease.

Purpose of the Study:

  • To estimate the health losses and TB program costs associated with each stage of the TB care cascade in Brazil.
  • To identify key gaps in the TB care cascade contributing to the overall disease burden.

Main Methods:

  • A Markov model was developed to simulate the TB care cascade and lifetime health outcomes in Brazil.
  • Models were stratified by age, HIV status, drug resistance, region, and disease severity, using data from national health information systems (SINAN, SIM).
  • Hypothetical scenarios were simulated to quantify health losses and costs associated with eliminating specific care cascade gaps.

Main Results:

  • Delayed diagnosis was the largest contributor to TB-attributable disability-adjusted life years (DALYs), followed by post-TB sequelae and loss to follow-up.
  • Eliminating delayed diagnosis could reduce TB DALYs by 71%, post-TB sequelae by 41%, and loss to follow-up by 10%.
  • Total health system costs were minimally affected by care cascade improvements, though TB diagnosis and treatment of false-positive cases represented 10.2% of programmatic costs.

Conclusions:

  • Delays in diagnosis, post-disease sequelae, and treatment loss to follow-up are primary drivers of the TB burden in Brazil.
  • Prioritizing the reduction of diagnostic delays, improving post-TB care, and minimizing treatment loss to follow-up are essential for mitigating the TB disease burden.