Rethinking Tuberculosis Treatment Abandonment in Latin America: A Biopsychosocial Perspective and an Integrated Model for Continuity of Care.

Background

Tuberculosis remains a major public health challenge in Latin America, where social inequalities, fragmented health systems, and barriers to care continue to undermine disease control. Although effective treatment is available, treatment abandonment and loss to follow-up remain persistent obstacles to successful outcomes.

Methods

A structured critical analysis of the contemporary literature on tuberculosis treatment abandonment and retention in care was conducted using a narrative evidence synthesis approach. Forty scientific documents published between 2018 and 2026 were included. Of these, 23 Latin American studies informed the results synthesis, while 13 international studies supported the comparative critical reflection.

Results

Findings were organised into five domains: social vulnerability, clinical complexity, health system barriers, priority populations, and protective factors and innovation. The evidence indicates that treatment abandonment is not an isolated individual behaviour, but a phenomenon associated with the convergence of social, clinical, and institutional determinants across the care trajectory. Poverty, migration, drug resistance, incarceration, weak follow-up systems, and fragmented care were repeatedly associated with discontinuity, whereas social support, active follow-up, digital tools, and economic measures were linked to improved adherence and retention in care.

Conclusions

From a biopsychosocial perspective, treatment abandonment should be understood as a systemic and preventable failure across the tuberculosis care continuum. The proposed Latin American Integrated Model for Retention in Tuberculosis Care (MILERTB) offers an anticipatory, equity-oriented, and person-centred framework to strengthen retention in care and guide future implementation research.