Challenges and adaptations in tuberculosis management during COVID-19 in Brazil

Background

Tuberculosis is linked to social determinants of health. During the pandemic period the management of tuberculosis has experienced a setback, especially with regard to vulnerable populations.

Aim

To analyze the repercussions of the COVID-19 pandemic on tuberculosis management in two priority Brazilian municipalities, comparing two service organization models: one municipality focused on outpatient treatment, while the other focused on decentralized treatment within the scope of primary health care.

Methods

In total, were interviewed 40 health and social assistance professionals who worked in TB management for at least six months during the pandemic. French Discourse Analysis was used.

Results

Two main discursive formations were identified: 1. Forced reorganization and digital barriers: the transition from in-person Directly Observed Treatment to remote monitoring via mobile devices compromised adherence, especially among highly vulnerable groups and illicit substance users, highlighting the limits of digital health regarding equity; 2. Intersectorality and creativity in crisis: the pandemic demanded improvised and creative responses to ensure access to social benefits (e.g., food assistance). The coordination between health and social assistance services was crucial to maintaining treatment for the homeless population.

Conclusions

The pandemic exacerbated weaknesses in tuberculosis control. The setbacks in treatment management for vulnerable populations demonstrate that the digitalization of care does not replace robust social protection networks. It is urgent to strengthen intersectoral strategies to mitigate the impact of social determinants in future health crises. The integration of social and health policies is necessary for tuberculosis control.

Key messages

• The setbacks in tuberculosis treatment management for vulnerable populations demonstrate the urgent of social protection networks.

• It is necessary to strengthen intersectoral strategies to mitigate the impact of social determinants on future health crises, and to integrate social and health policies for tuberculosis control.