{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:04:32Z","timestamp":1784574272027,"version":"3.55.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T00:00:00Z","timestamp":1779580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005639","name":"Universidade De S\u00e3o Paulo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005639","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Community Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To describe the sociodemographic and clinical profile of individuals with HIV-tuberculosis coinfection followed in services of the Brazilian Unified Health System (SUS), through the integration of data from the Qualiaids-Brazil Cohort and national health information systems. Methods: Nationwide observational study using data from the Qualiaids-BR Cohort, composed of people living with HIV\/AIDS (PLWHA) who initiated antiretroviral therapy (ART) between 2015 and 2018 in SUS services participating in the Qualiaids 2016\/2017 survey. Individuals with at least one episode of active tuberculosis after ART initiation were included. Results: A total of 7,747 individuals with HIV-tuberculosis coinfection were identified. The majority were men, young, mixed-race, with low educational levels, and residing in the Southeast region. Social vulnerabilities included alcohol, tobacco, or illicit drug use (&gt;\u200920%). Half presented an initial viral load\u2009&gt;\u2009100,000 copies\/mL and 60% had baseline CD4 counts\u2009&lt;\u2009200 cells\/mm\u00b3. Regarding tuberculosis, 80.3% were new cases, 9.5% re-entries, and 5.7% relapses. Treatment duration was concentrated between 6 and 12 months, with a cure rate of 70.9% and abandonment in 10.4% of cases, of which 21.3% also discontinued ART. Conclusion: Data integration enabled a comprehensive profile of HIV-tuberculosis coinfection, consistent with national findings and marked by social vulnerabilities that impact adherence and outcomes. The high proportion of treatment abandonment, also associated with ART discontinuation, highlights systemic weaknesses and the need for integrated care strategies for individuals with HIV-tuberculosis coinfection. The findings reinforce the importance of promoting comprehensive and continuous care to mitigate the impacts of coinfection.<\/jats:p>","DOI":"10.1007\/s10900-026-01585-8","type":"journal-article","created":{"date-parts":[[2026,5,24]],"date-time":"2026-05-24T11:51:27Z","timestamp":1779623487000},"page":"656-666","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HIV and Tuberculosis Coinfection in Brazil: Cohort Profile Monitored by the Unified Health System (2015\u20132018)"],"prefix":"10.1007","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3019-1154","authenticated-orcid":false,"given":"Evelyn Lima","family":"de Souza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9862-1603","authenticated-orcid":false,"given":"Maria Ines Battistella","family":"Nemes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7146-1643","authenticated-orcid":false,"given":"Ana Maroso","family":"Alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8601-5884","authenticated-orcid":false,"given":"Ana Paula Sayuri","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,24]]},"reference":[{"key":"1585_CR1","unstructured":"WHO - World Health Organization Tuberculosis [Internet]. 2024 [cited 2025 Jan 12]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tuberculosis"},{"key":"1585_CR2","unstructured":"Brasil Minist\u00e9rio da Sa\u00fade. Coinfec\u00e7\u00e3o tuberculose-HIV 2022. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade [Internet]. 2023 [cited 2025 Jan 12]. Available from: https:\/\/www.gov.br\/aids\/pt-br\/central-de-conteudo\/boletins-epidemiologicos\/2022\/coinfeccao-tb-hiv\/boletim_coinfeccao_tb_hiv_2022.pdf"},{"key":"1585_CR3","unstructured":"WHO - World Health Organization Global Tuberculosis Report 2024. Geneva: WHO [Internet]. 2024 [cited 2025 Jan 12]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/379339\/9789240101531-eng.pdf?sequence=1"},{"issue":"5","key":"1585_CR4","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1590\/0034-7167-2018-0285","volume":"72","author":"SH Bastos","year":"2019","unstructured":"Bastos, S. H., Taminato, M., Fernandes, H., Figueiredo, T. M. R. M., Nichiata, L. Y. I., & Hino, P. (2019). Sociodemographic and health profile of tuberculosis\/HIV co-infection in Brazil: a systematic review. Rev Bras Enferm, 72(5), 1389\u20131396. https:\/\/doi.org\/10.1590\/0034-7167-2018-0285","journal-title":"Rev Bras Enferm"},{"issue":"11","key":"1585_CR5","doi-asserted-by":"publisher","first-page":"e0207859","DOI":"10.1371\/journal.pone.0207859","volume":"13","author":"V Saraceni","year":"2018","unstructured":"Saraceni, V., Benzaken, A. S., Pereira, G. F. M., Andrade, K. B., Oliveira, P. B., Arakaki-Sanchez, D., et al. (2018). Tuberculosis burden on aids in Brazil: A study using linked databases. Plos One, 13(11), e0207859. https:\/\/doi.org\/10.1371\/journal.pone.0207859","journal-title":"Plos One"},{"issue":"1","key":"1585_CR6","doi-asserted-by":"publisher","first-page":"e5360","DOI":"10.25248\/reas.e5360.2021","volume":"13","author":"LF Macedo","year":"2021","unstructured":"Macedo, L. F., Bastos, T. R., Depr\u00e1, J. V. S., Feio, L. P. P., Braga, T. L. G. P., & Paes, A. L. V. (2021). Levantamento epidemiol\u00f3gico e fatores associados \u00e0 coinfec\u00e7\u00e3o tuberculose\/HIV no Brasil. Revista Eletr\u00f4nica Acervo Sa\u00fade, 13(1), e5360. https:\/\/doi.org\/10.25248\/reas.e5360.2021","journal-title":"Revista Eletr\u00f4nica Acervo Sa\u00fade"},{"issue":"2","key":"1585_CR7","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1590\/S0104-59702000000300004","volume":"7","author":"H Gon\u00e7alves","year":"2000","unstructured":"Gon\u00e7alves, H. (2000). A tuberculose ao longo dos tempos. Hist Cienc Saude Manguinhos, 7(2), 305\u2013327. https:\/\/doi.org\/10.1590\/S0104-59702000000300004","journal-title":"Hist Cienc Saude Manguinhos"},{"key":"1585_CR8","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1590\/S0034-89102007000800008","volume":"41","author":"MA Hijjar","year":"2007","unstructured":"Hijjar, M. A., Gerhardt, G., Teixeira, G. M., & Proc\u00f3pio, M. J. (2007). Retrospecto do controle da tuberculose no Brasil. Revista De Saude Publica, 41, 50\u201357. https:\/\/doi.org\/10.1590\/S0034-89102007000800008","journal-title":"Revista De Saude Publica"},{"issue":"4","key":"1585_CR9","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1097\/01.aids.0000279705.24428.a3","volume":"21","author":"DB Greco","year":"2007","unstructured":"Greco, D. B., & Sim\u00e3o, M. (2007). Brazilian policy of universal access to AIDS treatment: sustainability challenges and perspectives. Aids (London, England), 21(4), S37\u201345. https:\/\/doi.org\/10.1097\/01.aids.0000279705.24428.a3","journal-title":"Aids (London, England)"},{"key":"1585_CR10","unstructured":"Brasil. Minist\u00e9rio da Sa\u00fade Brasil Livre da Tuberculose: Plano Nacional pelo Fim da Tuberculose como Problema de Sa\u00fade P\u00fablica. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade [Internet]. 2021 [cited 2022 May 7]. Available from: https:\/\/www.google.com\/url?q=http:\/\/www.aids.gov.br\/pt-br\/pub\/2021\/brasil-livre-da-tuberculose&sa=D&source=docs&ust=1652624450300463&usg=AOvVaw1eNi9aTr-GcoTv4XEexkY2"},{"key":"1585_CR11","unstructured":"Brasil Minist\u00e9rio da Sa\u00fade. Sistemas de Informa\u00e7\u00e3o [internet]. [s.d.] [cited 2022 May 15]. Available from: https:\/\/www.gov.br\/aids\/pt-br\/sistemas-de-informacao"},{"issue":"7","key":"1585_CR12","doi-asserted-by":"publisher","first-page":"e00182119","DOI":"10.1590\/0102-311X00182119","volume":"37","author":"GC Coelho Neto","year":"2021","unstructured":"Coelho Neto, G. C., & Chioro, A. (2021). Afinal, quantos Sistemas de Informa\u00e7\u00e3o em Sa\u00fade de base nacional existem no Brasil? Cad Saude Publica, 37(7), e00182119. https:\/\/doi.org\/10.1590\/0102-311X00182119","journal-title":"Cad Saude Publica"},{"issue":"2","key":"1585_CR13","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.bjid.2016.11.006","volume":"21","author":"TN Prado","year":"2017","unstructured":"Prado, T. N., Rajan, J. V., Miranda, A. E., Dias, E. S., Cosme, L. B., Possuelo, L. G., et al. (2017). Clinical and epidemiological characteristics associated with unfavorable tuberculosis treatment outcomes in tuberculosis-HIV co-infected patients in Brazil: a hierarchical polytomous analysis. The Brazilian Journal Of Infectious Diseases : An Official Publication Of The Brazilian Society Of Infectious Diseases, 21(2), 162\u2013170. https:\/\/doi.org\/10.1016\/j.bjid.2016.11.006","journal-title":"The Brazilian Journal Of Infectious Diseases : An Official Publication Of The Brazilian Society Of Infectious Diseases"},{"key":"1585_CR14","doi-asserted-by":"publisher","first-page":"66","DOI":"10.11606\/s1518-8787.2023057005256","volume":"57","author":"APS Sato","year":"2023","unstructured":"Sato, A. P. S., Nemes, M. I. B., Alves, A. M., Souza, E. L., Reis-Santos, B., Nunes, L. O., et al. (2023). Perfil da coorte de pessoas em tratamento da infec\u00e7\u00e3o por HIV no SUS, Brasil, 2015\u20132018. Revista De Saude Publica, 57, 66. https:\/\/doi.org\/10.11606\/s1518-8787.2023057005256","journal-title":"Revista De Saude Publica"},{"key":"#cr-split#-1585_CR15.1","unstructured":"Alves, A. M. Avalia\u00e7\u00e3o da organiza\u00e7\u00e3o dos servi\u00e7os ambulatoriais do SUS que tratam pessoas vivendo com HIV no Brasil: an\u00e1lise do inqu\u00e9rito Qualiaids 2016\/2017 [tese]. S\u00e3o Paulo: Universidade de S\u00e3o Paulo, Faculdade de Medicina [Internet]"},{"key":"#cr-split#-1585_CR15.2","unstructured":"2022 [cited 2024 Jul 20]. Available from: https:\/\/www.teses.usp.br\/teses\/disponiveis\/5\/5137\/tde-27012023-124124\/en.php"},{"issue":"1","key":"1585_CR16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.11606\/s1518-8787.2023057004476","volume":"57","author":"AM Alves","year":"2023","unstructured":"Alves, A. M., Santos, A. C., Kumow, A., Sato, A. P. S., Helena, E. T. S., & Nemes, M. I. B. (2023). Para al\u00e9m do acesso ao medicamento: papel do SUS e perfil da assist\u00eancia em HIV no Brasil. Revista De Saude Publica, 57(1), 26. https:\/\/doi.org\/10.11606\/s1518-8787.2023057004476","journal-title":"Revista De Saude Publica"},{"issue":"11","key":"1585_CR17","doi-asserted-by":"publisher","first-page":"e0305311","DOI":"10.1371\/journal.pone.0305311","volume":"19","author":"MIB Nemes","year":"2024","unstructured":"Nemes, M. I. B., Sato, A. P. S., Reis-Santos, B., Alves, A. M., Nascimento, F. P., & Agins, B. (2024). Time from treatment initiation to HIV viral suppression in public care sites in Brazil: a nationwide linked databases cohort. Plos One, 19(11), e0305311. https:\/\/doi.org\/10.1371\/journal.pone.0305311","journal-title":"Plos One"},{"key":"1585_CR18","unstructured":"Brasil Minist\u00e9rio da Sa\u00fade. Manual de Recomenda\u00e7\u00f5es para o Controle da Tuberculose no Brasil. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade [Internet]. 2019 [cited 2021 Jan 27]. Available from: https:\/\/bvsms.saude.gov.br\/bvs\/publicacoes\/manual_recomendacoes_controle_tuberculose_brasil_2_ed.pdf"},{"key":"1585_CR19","unstructured":"Posit team (2024). RStudio: Integrated Development Environment for R. Posit Software, PBC, Boston, MA [cited 2024 Jul 26]. Available from: http:\/\/www.posit.co\/"},{"issue":"4","key":"1585_CR20","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1590\/S1020-49892013000400009","volume":"33","author":"A San Pedro","year":"2013","unstructured":"San Pedro, A., & Oliveira, R. M. (2013). Tuberculose e indicadores socioecon\u00f4micos: revis\u00e3o sistem\u00e1tica da literatura. Revista Panamericana De Salud Publica, 33(4), 294\u2013301. https:\/\/doi.org\/10.1590\/S1020-49892013000400009","journal-title":"Revista Panamericana De Salud Publica"},{"key":"1585_CR21","doi-asserted-by":"publisher","first-page":"e20230077","DOI":"10.1590\/1983-1447.2023.20230077.en","volume":"44","author":"LV Lima","year":"2023","unstructured":"Lima, L. V., Pavinati, G., Palmieri, I. G. S., Vieira, J. P., Blasque, J. C., Higarashi, I. H., et al. (2023). Factors associated with loss to follow-up in tuberculosis treatment in Brazil: a retrospective cohort study. Rev Gaucha Enferm, 44, e20230077. https:\/\/doi.org\/10.1590\/1983-1447.2023.20230077.en","journal-title":"Rev Gaucha Enferm"},{"key":"1585_CR22","doi-asserted-by":"publisher","first-page":"e0155","DOI":"10.1590\/0037-8682-0155-2022","volume":"56","author":"LA de Lucena","year":"2023","unstructured":"de Lucena, L. A., Dantas, G. B. S., Carneiro, T. V., & Lacerda, H. G. (2023). Factors Associated with the Abandonment of Tuberculosis Treatment in Brazil: A Systematic Review. Revista Da Sociedade Brasileira De Medicina Tropical, 56, e0155\u20132022. https:\/\/doi.org\/10.1590\/0037-8682-0155-2022","journal-title":"Revista Da Sociedade Brasileira De Medicina Tropical"},{"issue":"1","key":"1585_CR23","first-page":"28","volume":"38","author":"EL Maciel","year":"2015","unstructured":"Maciel, E. L., & Reis-Santos, B. (2015). Determinants of tuberculosis in Brazil: from conceptual framework to practical application. Revista Panamericana De Salud Publica, 38(1), 28\u201334. PMID: 26506318.","journal-title":"Revista Panamericana De Salud Publica"},{"key":"1585_CR24","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1186\/s12879-024-09417-7","volume":"24","author":"DK Ryuk","year":"2024","unstructured":"Ryuk, D. K., Pelissari, D. M., Alves, K., Oliveira, P. B., Castro, M. C., Cohen, T., et al. (2024). Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records. Bmc Infectious Diseases, 24, 531. https:\/\/doi.org\/10.1186\/s12879-024-09417-7","journal-title":"Bmc Infectious Diseases"},{"issue":"3","key":"1585_CR25","doi-asserted-by":"publisher","first-page":"e2017464","DOI":"10.5123\/S1679-49742018000300015","volume":"27","author":"JN dos Santos","year":"2018","unstructured":"dos Santos, J. N., Sales, C. M. M., Prado, T. N., & Maciel, E. L. (2018). Fatores associados \u00e0 cura no tratamento da tuberculose no estado do Rio de Janeiro, 2011\u20132014. Epidemiol Serv Saude, 27(3), e2017464. https:\/\/doi.org\/10.5123\/S1679-49742018000300015","journal-title":"Epidemiol Serv Saude"},{"key":"1585_CR26","unstructured":"Brasil Minist\u00e9rio da Sa\u00fade. Protocolo Cl\u00ednico e Diretrizes Terap\u00eauticas para Manejo da Infec\u00e7\u00e3o pelo HIV em Adultos: M\u00f3dulo 2: Coinfec\u00e7\u00f5es e Infec\u00e7\u00f5es Oportunistas. Bras\u00edlia: Minist\u00e9rio da Sa\u00fade [Internet], 2024 [cited 2024 Aug 05]. Available from: https:\/\/www.gov.br\/aids\/pt-br\/central-de-conteudo\/pcdts\/PCDT_HIV_Modulo_2_2024_eletrnicoISBN.pdf"},{"issue":"10","key":"1585_CR27","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.5588\/ijtld.14.0776","volume":"19","author":"B Reis-Santos","year":"2015","unstructured":"Reis-Santos, B., Pellacani-Posses, I., Macedo, L. R., Golub, J. E., Riley, L. W., & Maciel, E. L. (2015). Directly observed therapy of tuberculosis in Brazil: associated determinants and impact on treatment outcome. The International Journal Of Tuberculosis And Lung Disease, 19(10), 1188\u20131193. https:\/\/doi.org\/10.5588\/ijtld.14.0776","journal-title":"The International Journal Of Tuberculosis And Lung Disease"},{"key":"1585_CR28","doi-asserted-by":"publisher","first-page":"e2798","DOI":"10.1590\/1518-8345.1187.2798","volume":"24","author":"GT Magnabosco","year":"2016","unstructured":"Magnabosco, G. T., Lopes, L. M., Andrade, L. R. P., Brunello, M. E. F., Monroe, A. A., & Villa, T. C. S. (2016). Tuberculosis control in people living with HIV\/AIDS. Rev Lat Am Enfermagem, 24, e2798. https:\/\/doi.org\/10.1590\/1518-8345.1187.2798","journal-title":"Rev Lat Am Enfermagem"},{"issue":"2","key":"1585_CR29","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1590\/S1806-37132013000200014","volume":"39","author":"NP Santos","year":"2013","unstructured":"Santos, N. P., L\u00edrio, M., Passos, L. A. R., Dias, J. P., Kritski, A. L., Galv\u00e3o-Castro, A. B., et al. (2013). Completeness of tuberculosis reporting forms in five Brazilian capitals with a high incidence of the disease. J Bras Pneumol, 39(2), 221\u2013225. https:\/\/doi.org\/10.1590\/S1806-37132013000200014","journal-title":"J Bras Pneumol"},{"issue":"2","key":"1585_CR30","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1590\/1414-462X201500020092","volume":"23","author":"MS Rocha","year":"2015","unstructured":"Rocha, M. S., Aguiar, F. P., Oliveira, G. P., Saraceni, V., Coeli, C. M., & Pinheiro, R. S. (2015). Reliability of treatment outcome for tuberculosis using record linkage. Cad Saude Colet, 23(2), 150\u2013156. https:\/\/doi.org\/10.1590\/1414-462X201500020092","journal-title":"Cad Saude Colet"},{"issue":"2","key":"1585_CR31","doi-asserted-by":"publisher","first-page":"e0212617","DOI":"10.1371\/journal.pone.0212617","volume":"14","author":"B Reis-Santos","year":"2019","unstructured":"Reis-Santos, B., Shete, P., Bertolde, A., Sales, C. M., Sanchez, M. N., Arakaki-Sanchez, D., et al. (2019). Tuberculosis in Brazil and cash transfer programs: A longitudinal database study of the effect of cash transfer on cure rates. Plos One, 14(2), e0212617. https:\/\/doi.org\/10.1371\/journal.pone.0212617","journal-title":"Plos One"},{"issue":"1","key":"1585_CR32","doi-asserted-by":"publisher","first-page":"e2019017","DOI":"10.5123\/s1679-49742020000100009","volume":"29","author":"MS Rocha","year":"2020","unstructured":"Rocha, M. S., Bartholomay, P., Cavalcante, M. V., Medeiros, F. C., Codenotti, S. B., Pelissari, D. M., et al. (2020). Sistema de Informa\u00e7\u00e3o de Agravos de Notifica\u00e7\u00e3o (Sinan): principais caracter\u00edsticas da notifica\u00e7\u00e3o e da an\u00e1lise de dados relacionada \u00e0 tuberculose. Epidemiol Serv Saude, 29(1), e2019017. https:\/\/doi.org\/10.5123\/s1679-49742020000100009","journal-title":"Epidemiol Serv Saude"},{"key":"1585_CR33","unstructured":"Brasil Minist\u00e9rio da Sa\u00fade [Internet]. Sistema de Informa\u00e7\u00e3o de Agravos de Notifica\u00e7\u00e3o - SINANWEB [s.d.] [cited 2024 Aug 05]. Available from: http:\/\/portalsinan.saude.gov.br\/tuberculose"}],"container-title":["Journal of Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10900-026-01585-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10900-026-01585-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10900-026-01585-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:46:40Z","timestamp":1784573200000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10900-026-01585-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,24]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["1585"],"URL":"https:\/\/doi.org\/10.1007\/s10900-026-01585-8","relation":{},"ISSN":["0094-5145","1573-3610"],"issn-type":[{"value":"0094-5145","type":"print"},{"value":"1573-3610","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,24]]},"assertion":[{"value":"9 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. There are no personal data of any individual in the manuscript in any form.","order":2,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Research Ethics Committee for Human Subjects of the School of Medicine of the University of S\u00e3o Paulo on January 23, 2020 (CAAE: 27659220.3.0000.0065; Opinion: 3.807.435).","order":3,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}