{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T23:53:13Z","timestamp":1793490793732,"version":"4.5.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Globally, tuberculosis (TB) surveillance and care were severely impacted by the COVID-19 pandemic. In Brazil, TB notification rates decreased in the first 2 years of the pandemic. There is a need for rigorous model-based methods to quantify the impact of health system disruptions on TB control. In this study, we aimed to assess how the COVID-19 pandemic affected both incidence and case detection in Brazilian states.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used a Bayesian evidence synthesis model to estimate TB incidence and case detection rates over the period 2016\u201321 by using routinely collected case notification and mortality data. We then used a meta-regression framework to estimate factors associated with state-level rates of undiagnosed symptomatic TB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found that the probability that an individual with symptomatic TB was diagnosed decreased in the majority of states in April 2020 (median\u2009=\u2009\u201310.4%age points, interquartile range\u2009=\u2009\u20136.6, \u201316.2). Incident TB decreased slightly in April 2020 and rebounded beginning in 2021. Together, this led to an increase in missed TB cases in nearly every state during the pandemic. Nationally, we estimate that there were 20 671 (95% credible interval: 19 249, 22 501) missed TB cases between April 2020 and December 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Disruptions to the Brazilian healthcare system during the COVID-19 pandemic prevented tens of thousands of individuals with symptomatic disease from receiving a TB diagnosis. While some Brazilian states recovered rapidly to pre-pandemic levels of TB case detection, many did not and the rates of missed TB cases remained high through 2021.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ije\/dyaf146","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T11:52:19Z","timestamp":1755777139000},"source":"Crossref","is-referenced-by-count":3,"title":["Quantifying disruptions to tuberculosis case detection in Brazilian states during the COVID-19 pandemic"],"prefix":"10.1093","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9289-5694","authenticated-orcid":false,"given":"Melanie H","family":"Chitwood","sequence":"first","affiliation":[{"name":"Epidemiology of Microbial Diseases, Yale School of Public Health , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas A","family":"Menzies","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Bartholomay","sequence":"additional","affiliation":[{"name":"Health and Environment Surveillance Secretariat, Ministry of Health , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele Maria","family":"Pelissari","sequence":"additional","affiliation":[{"name":"Health and Environment Surveillance Secretariat, Ministry of Health , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Nildo de Barros Silva J\u00fanior","sequence":"additional","affiliation":[{"name":"Health and Environment Surveillance Secretariat, Ministry of Health , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiza Ohana","family":"Harada","sequence":"additional","affiliation":[{"name":"Health and Environment Surveillance Secretariat, Ministry of Health , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Dockhorn Costa","family":"Johansen","sequence":"additional","affiliation":[{"name":"Health and Environment Surveillance Secretariat, Ministry of Health , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethel Leonor Noia","family":"Maciel","sequence":"additional","affiliation":[{"name":"Health and Environment Surveillance Secretariat, Ministry of Health , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4606-2795","authenticated-orcid":false,"given":"Marcia C","family":"Castro","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard T.H. Chan School of Public Health , Boston, MA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Bras\u00edlia , Brasilia,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua L","family":"Warren","sequence":"additional","affiliation":[{"name":"Biostatistics, Yale School of Public Health , New Haven CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8091-7198","authenticated-orcid":false,"given":"Ted","family":"Cohen","sequence":"additional","affiliation":[{"name":"Epidemiology of Microbial Diseases, Yale School of Public Health , New Haven, CT,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"2025091919410928500_dyaf146-B1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1186\/s13690-022-01012-z","article-title":"COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management","volume":"80","author":"Szwarcwald","year":"2022","journal-title":"Arch Public Health"},{"key":"2025091919410928500_dyaf146-B2","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S0140-6736(19)31243-7","article-title":"Brazil\u2019s unified health system: the first 30 years and prospects for the future","volume":"394","author":"Castro","year":"2019","journal-title":"Lancet"},{"key":"2025091919410928500_dyaf146-B3","doi-asserted-by":"crossref","first-page":"e1463","DOI":"10.1016\/S2214-109X(22)00320-5","article-title":"Excess tuberculosis cases and deaths following an economic recession in Brazil: an analysis 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an application in Brazil","volume":"35","author":"Chitwood","year":"2021","journal-title":"Epidemics."},{"key":"2025091919410928500_dyaf146-B14","author":"Brasil Minist\u00e9rio da Sa\u00fade"},{"key":"2025091919410928500_dyaf146-B15","author":"Brasil Minist\u00e9rio da Sa\u00fade"},{"key":"2025091919410928500_dyaf146-B16","author":"Sistema IBGE de Recupera\u00e7\u00e3o Autom\u00e1tica\u2013SIDRA"},{"key":"2025091919410928500_dyaf146-B17"},{"key":"2025091919410928500_dyaf146-B18","author":"Stan Development Team","year":"2024"},{"key":"2025091919410928500_dyaf146-B19","author":"R Core Team","year":"2023"},{"key":"2025091919410928500_dyaf146-B20","doi-asserted-by":"crossref","first-page":"e0001271","DOI":"10.1371\/journal.pgph.0001271","article-title":"Meeting the 2030 END TB goals in the wake of COVID-19: A modelling study of countries in the USAID TB portfolio","volume":"3","author":"Arinaminpathy","year":"2023","journal-title":"PLOS Glob Public 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