{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:57:22Z","timestamp":1779188242890,"version":"3.51.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100002322","name":"CAPES","doi-asserted-by":"publisher","award":["001"],"award-info":[{"award-number":["001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Social inequalities play a crucial role in the incidence of TB, making it plausible that they act as effect modifiers on the impact of active case-finding (ACF) strategies in the detection of the disease. We estimated the association between ACF strategies and TB detection rates and evaluated their effect modification due to social inequalities in Brazilian municipalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 5033 municipalities that reported at least one new TB case. We defined the TB detection rate as the outcome variable. Our exposure variables were the proportion of primary care team (PCT) reporting community-based ACF for TB and household contact investigation (HCI) of new TB cases. We also assessed the Municipal Human Development Index (MHDI) and the Social Vulnerability Index (SVI) as potential effect modifier variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The TB detection rate was positively associated with both the proportion of PCTs conducting community-based ACF and the proportion conducting HCI. These associations weakened as MHDI increased (interaction incident rate ratio [IRR] 0.95, 95% CI 0.90 to 0.98 for ACF; IRR 0.93, 95% CI 0.89 to 0.96 for HCI) and strengthened with higher SVI values (IRR 1.11, 95% CI 1.02 to 1.22 and IRR 1.17, 95% CI 1.08 to 1.27, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Social inequalities in Brazilian municipalities modify the effect of ACF strategies on TB detection rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/trstmh\/traf086","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T11:55:51Z","timestamp":1754049351000},"page":"9-17","source":"Crossref","is-referenced-by-count":2,"title":["Social inequalities as effect modifiers of active case-finding strategies for tuberculosis in Brazil: an ecological study"],"prefix":"10.1093","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6674-0939","authenticated-orcid":false,"given":"Jos\u00e9 M\u00e1rio Nunes","family":"da Silva","sequence":"first","affiliation":[{"name":"Postgraduate Program in Epidemiology, School of Public Health, University of S\u00e3o Paulo , Av. Dr Arnaldo, 715, S\u00e3o Paulo, SP 01246-904 ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-1930","authenticated-orcid":false,"given":"Fredi Alexander","family":"Diaz-Quijano","sequence":"additional","affiliation":[{"name":"School of Public Health, University of S\u00e3o Paulo Department of Epidemiology - Laborat\u00f3rio de Infer\u00eancia Causal em Epidemiologia (LINCE-USP), , Av. Dr Arnaldo, 715, S\u00e3o Paulo, SP 01246-904 ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"2026010505422848600_bib1","volume-title":"Global Tuberculosis Report 2024","author":"World Health Organization","year":"2024"},{"issue":"1","key":"2026010505422848600_bib2","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1186\/s12889-023-15213-w","article-title":"The social determinants of national tuberculosis incidence rates in 116 countries: a longitudinal ecological study between 2005\u20132015","volume":"23","author":"K\u00f6ltringer","year":"2023","journal-title":"BMC Public Health"},{"issue":"1","key":"2026010505422848600_bib3","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/1755-7682-7-35","article-title":"Individual and social vulnerabilities upon acquiring tuberculosis: a literature systematic review","volume":"7","author":"Lacerda","year":"2014","journal-title":"Int Arch Med"},{"issue":"1","key":"2026010505422848600_bib4","doi-asserted-by":"crossref","first-page":"e0247894","DOI":"10.1371\/journal.pone.0247894","article-title":"Time trend, social vulnerability, and identification of risk areas for tuberculosis in Brazil: an ecological study","volume":"17","author":"de Paiva","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"2026010505422848600_bib5","first-page":"23","article-title":"Impact of incarceration on tuberculosis incidence and its interaction with income distribution inequality in Brazil","volume":"114","author":"Pelissari","year":"2020","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"4","key":"2026010505422848600_bib6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0176116","article-title":"Household crowding as a potential mediator of socioeconomic determinants of tuberculosis incidence in Brazil","volume":"12","author":"Pelissari","year":"2017","journal-title":"PLoS One"},{"issue":"3","key":"2026010505422848600_bib7","first-page":"177","article-title":"Social determinants and inequalities in tuberculosis incidence in Latin America and the Caribbean","volume":"38","author":"Munayco","year":"2015","journal-title":"Rev Panam Salud Publica"},{"issue":"3","key":"2026010505422848600_bib8","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/tmi.13349","article-title":"Determinants associated with areas with higher tuberculosis mortality rates: an ecological study","volume":"25","author":"Lima","year":"2020","journal-title":"Trop Med Int Health"},{"issue":"14","key":"2026010505422848600_bib9","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1017\/S0950268818001929","article-title":"Is there association between human development index and tuberculosis mortality risk? 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