Epidemiological, Socioeconomic, and Health Service Factors Associated with Tuberculosis Treatment Interruption in...

Background: Brazil must make progress toward eliminating tuberculosis as a public health problem and achieving the goal of reducing treatment interruption to below 5%. Improving adherence requires a thorough understanding of the factors that influence this outcome. Objectives: To identify epidemiological, socioeconomic, and health service-related factors associated with tuberculosis treatment interruption in Brazilian municipalities from 2018 to 2022. Methods: This ecological study utilized secondary data from all Brazilian municipalities. Independent variables were organized into three blocks: epidemiological, health service coverage, and socioeconomic. A zero-inflated beta regression model was employed to analyze both the proportion and zero-inflated components. Results: The mean treatment interruption rate was 8.1%. Interruption was associated with the proportion of laboratory-confirmed cases, Family Health Strategy coverage, and the proportion of the population residing in rural areas. Tuberculosis incidence, sputum smear microscopy, molecular rapid tests, contact investigation, directly observed therapy, AIDS detection rate, Gini index, household crowding, and illiteracy were associated with treatment adherence. In the zero-inflated component, directly observed therapy, consultations per inhabitant, illiteracy, and the proportion of the population residing in rural areas increased the probability of a zero-interruption rate, whereas TB incidence, AIDS detection, municipal population, and household crowding decreased that probability. Conclusions: Tuberculosis treatment interruption in Brazil is shaped by socioeconomic, epidemiological, and health service factors, highlighting the need for integrated strategies that combine social protection with strengthened primary care to improve adherence and progress toward elimination goals.