Abstract
BACKGROUND: To study the unfavorable outcomes of tuberculosis treatment, presenting individual, social, and program vulnerabilities in homeless, HIV-infected individuals and individuals living in areas of high social vulnerability in the city of São Paulo. METHODS: Cases were reported, confirmed, and monitored using the tuberculosis control program in the city of São Paulo. Social vulnerability was assessed using the São Paulo Social Vulnerability Index (SVI). Individuals analyzed in the study with more than one vulnerability condition were allocated to more than one vulnerability group, and the outcomes were analyzed separately. The reference category included the remaining cases. The following outcomes were examined: death, treatment abandonment, tuberculosis recurrence, and drug resistance. RESULTS: A total of 14,221 cases reported in 2019 and 2021 were studied; 11,322 lived in areas of high social vulnerability, 2,753 were HIV-infected, and 1,388 were homeless (the total exceeded 14,221, given that there were individuals with more than one vulnerability). All groups had higher incidence, prevalence, and mortality rates, as well as a higher risk of unfavorable outcomes. The risks were highest for homeless individuals, followed by HIV-infected individuals and those living in areas of high social vulnerability. CONCLUSIONS: Compared to individuals without the analyzed vulnerabilities, we found that unfavorable tuberculosis treatment outcomes were associated with different types of vulnerabilities, reflecting individual, social, and program vulnerabilities. Although the individuals studied had access to treatment, several vulnerabilities impacted the likelihood of successful treatment and challenged the tuberculosis control.