Impact of the COVID-19 pandemic on unfavorable tuberculosis outcomes: a comparative analysis of unhoused and general populations.

INTRODUCTION

Tuberculosis care has been seriously affected by the COVID-19 pandemic. Few studies have assessed the impact of the pandemic on tuberculosis outcomes in vulnerable populations. We aimed to evaluate tuberculosis outcomes before and during the pandemic in general and in unhoused populations in São Paulo, Brazil.

METHODS

We performed a retrospective cohort study that compared tuberculosis outcomes between the unhoused and general populations using data from 2017 to 2019 and 2020 to 2022. Unfavorable outcomes were defined as loss to follow-up, treatment failure, death, toxicity, and resistance to drugs. Cox regression models and Kaplan‒Meier curves were used to evaluate the data.

RESULTS

Among 47,293 patients diagnosed with tuberculosis using the National Notifiable Diseases Information System (SINAN) between January 1, 2017, and December 31, 2021, 29,247 patients were included in our study. Patients diagnosed with TB during the pandemic were more likely to have unfavorable outcomes in the general population (hazard ratio [HR], 1.45, [95% confidence interval (CI), 1.37 to 1.55], p < 0.001), but not in the unhoused population. Patients with lost to follow-up (HR, 1.42, 95% CI 1.21-1.66, p < 0.001) or hospitalized (HR, 1.50, 95%CI 1.29-1.74, p < 0.001) were more likely to experience unfavorable outcomes in the unhoused population.

CONCLUSIONS

In conclusion, during the pandemic of COVID-19 period the tuberculosis care was not affected in the specific unhoused population but rather affected the general population in the largest city of São Paulo, Brazil.