Effects of the Covid-19 Pandemic on Tuberculosis Treatment Continuity: An Ecological Time-Series Study

Tuberculosis is among the most relevant infectious diseases nationally and is considered one of the leading causes of preventable death in Brazil. The COVID-19 pandemic negatively impacted TB treatment processes. This study aimed to analyze adherence indicators for pulmonary and extrapulmonary TB treatment in Brazil in the pre-pandemic and post-pandemic-onset periods. Ecological time-series study using secondary data extracted from the Notifiable Diseases Information System (SINAN) via the DATASUS platform. Absolute numbers of cures, treatment abandonment, and primary abandonment were analyzed across Brazilian regions. Confirmed TB cases from 2015 to 2024 were included. A comparative analysis was performed between 2015–2019 (pre-pandemic) and 2020–2024 (post-pandemic onset). Brazil recorded 502,648 TB cases, with 308,164 cures, 57,410 abandonments, and 3,806 primary abandonments. From 2020 to 2024, there were 502,271 cases, with 275,602 cures, 74,764 abandonments, and 3,756 primary abandonments. There was a 10.6% reduction in cures and a 30.2% increase in abandonments in the post-pandemic period, while primary abandonment remained relatively stable. Regionally, the Central-West had the largest drop in cures (17.8%) and a 7% increase in abandonments. In the Northeast, abandonments increased by 28% and cures fell by 11.5%. The Southeast showed an 11% reduction in cures and a 21% increase in abandonments. In the North, cures decreased by 9% and abandonments rose by 19.6%. In the South, cures fell by 4.3% and abandonments increased by 21.6%. The COVID-19 pandemic may have directly influenced TB treatment adherence, reducing cure rates and significantly increasing treatment abandonment, which can compromise disease control and raise the risk of drug resistance. These findings reinforce the need to strengthen surveillance policies, active case-finding, and patient follow-up, especially during health crises.