{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:02:55Z","timestamp":1793131375319,"version":"4.5.0"},"reference-count":28,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. bras. epidemiol."],"abstract":"<jats:p>ABSTRACT  Objective:  To analyze temporal trends and state-level clusters of tuberculosis treatment interruption indicators among the homeless population in Brazil.  Methods:  This is an ecological study, in which treatment interruption among homeless people with tuberculosis was assessed from 2015 to 2023. Joinpoint regression was used for trend analysis, stratified by sociodemographic and epidemiological variables. State clusters were identified by k-means clustering analysis, based on socioeconomic and programmatic indicators.  Results:  Tuberculosis treatment interruption increased among: men (average quarterly percent change - AQPC=0.15; 95% confidence interval - 95%CI 0.04-0.29), individuals aged 40-59 years (AQPC=0.38; 95%CI 0.25-0.53), tobacco users (AQPC=0.72; 95%CI 0.61-0.82), beneficiaries of social programs (AQPC=4.59; 95%CI 3.69-6.02), those without directly observed treatment (AQPC=0.49; 95%CI 0.39-0.63), without HIV coinfection (AQPC=0.38; 95%CI 0.30-0.51), and in the North (AQPC=1.51; 95%CI 0.96-2.21) and Midwest (AQPC=0.83; 95%CI 0.17-1.59) regions. According to the cluster analysis, cluster A had the lowest treatment interruption rate, low AIDS incidence, and better programmatic indicators. Cluster B had high poverty and low level of education and income, but strong primary health care performance. Cluster C stood out for its higher human development, better social indicators, and lower inequality. Cluster D concentrated the worst outcomes: higher treatment interruption, greater inequality, higher AIDS incidence, and weaker primary health care.  Conclusion:  Socioeconomic and programmatic inequalities were evident in access and attachment to tuberculosis treatment among people experiencing homelessness in Brazil.<\/jats:p>","DOI":"10.1590\/1980-549720250041","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T13:21:32Z","timestamp":1754659292000},"source":"Crossref","is-referenced-by-count":4,"title":["Trends and clusters of tuberculosis treatment interruption among people experiencing homelessness in Brazil: influence of individual, social and programmatic factors"],"prefix":"10.1590","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0289-8219","authenticated-orcid":false,"given":"Gabriel","family":"Pavinati","sequence":"first","affiliation":[{"name":"Universidade Estadual de Maring\u00e1,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9582-9641","authenticated-orcid":false,"given":"Lucas Vin\u00edcius de","family":"Lima","sequence":"additional","affiliation":[{"name":"Secretaria Municipal de Sa\u00fade,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1694-5124","authenticated-orcid":false,"given":"Melisane Regina Lima","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Minist\u00e9rio da Sa\u00fade,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3891-0080","authenticated-orcid":false,"given":"Simone Teresinha Protti","family":"Zanatta","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Carlos,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3318-6748","authenticated-orcid":false,"given":"Gabriela Tavares","family":"Magnabosco","sequence":"additional","affiliation":[{"name":"Universidade Estadual de Maring\u00e1,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref1","series-title":"Global Tuberculosis Report 2023","year":"2024"},{"issue":"4","key":"ref2","doi-asserted-by":"crossref","first-page":"514","DOI":"10.4046\/trd.2023.0197","article-title":"Prevalence and Characteristics of tuberculosis in the Korean homeless population based on nationwide tuberculosis screening","volume":"87","author":"Han H","year":"2024","journal-title":"Tuberc Respir Dis"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1128525","DOI":"10.3389\/fpubh.2023.1128525","article-title":"Prevalence of pulmonary tuberculosis in homeless individuals in the Addis Ababa City, Ethiopia","volume":"11","author":"Shamebo T","year":"2023","journal-title":"Front Public Health"},{"issue":"3","key":"ref4","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ijtb.2022.11.001","article-title":"To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India","volume":"70","author":"Chopra KK","year":"2023","journal-title":"Indian J Tuberc"},{"issue":"7","key":"ref5","article-title":"Vulnerabilidade \u00e0 perda de seguimento e ao \u00f3bito por tuberculose nas pessoas em situa\u00e7\u00e3o de rua no Brasil: um estudo de coorte retrospectiva","volume":"29","author":"Pavinati G","year":"2024","journal-title":"Ci\u00eanc Sa\u00fade Coletiva"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","DOI":"10.1590\/0102-311xpt051122","article-title":"Perfil sociodemogr\u00e1fico das pessoas em situa\u00e7\u00e3o de rua notificadas com tuberculose no Munic\u00edpio do Rio de Janeiro, Brasil, nos anos de 2015 a 2019","volume":"39","author":"Gioseffi JR","year":"2024","journal-title":"Cad Sa\u00fade P\u00fablica"},{"key":"ref7","series-title":"Boletim Epidemiol\u00f3gico - Tuberculose 2025","year":"2025"},{"key":"ref8","doi-asserted-by":"crossref","DOI":"10.1590\/1980-549720230048.2","article-title":"Disparidades geoprogram\u00e1ticas do desempenho de indicadores da tuberculose na popula\u00e7\u00e3o em situa\u00e7\u00e3o de rua no Brasil: uma abordagem ecol\u00f3gica","volume":"26","author":"Pavinati G","year":"2023","journal-title":"Rev Bras Epidemiol"},{"key":"ref9","doi-asserted-by":"crossref","DOI":"10.4025\/actascihealthsci.v46i1.65508","article-title":"Characterization of the homeless people affected by tuberculosis in Brazil, 2015 to 2021","volume":"46","author":"Pavinati G","year":"2024","journal-title":"Acta Scientiarum. Health Sciences"},{"issue":"2","key":"ref10","article-title":"A critical analysis of the decreasing trends in tuberculosis cure indicators in Brazil, 2001-2022","volume":"50","author":"Pavinati G","year":"2024","journal-title":"J Bras Pneumol"},{"key":"ref11","series-title":"Popula\u00e7\u00e3o em situa\u00e7\u00e3o de rua: diagn\u00f3stico com base nos dados e informa\u00e7\u00f5es dispon\u00edveis em registros administrativos e sistemas do Governo Federal","year":"2024"},{"key":"ref12","series-title":"Caderno de Indicadores da Tuberculose: Tuberculose Sens\u00edvel, Tuberculose Drogarresistente e Tratamento Preventivo","year":"2024"},{"key":"ref13","series-title":"Joinpoint Trend Analysis Software"},{"key":"ref14","article-title":"Factors associated with loss to follow-up in tuberculosis treatment in Brazil: a retrospective cohort study","volume":"44","author":"Lima LV","year":"2023","journal-title":"Rev Ga\u00facha Enferm"},{"issue":"15","key":"ref15","doi-asserted-by":"crossref","first-page":"5626","DOI":"10.3390\/ijerph17155626","article-title":"Factors influencing patient adherence to tuberculosis treatment in Ethiopia: a literature review","volume":"17","author":"Nezenega ZS","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref16","series-title":"Enfermagem em sa\u00fade mental e COVID-19","first-page":"45","volume-title":"Popula\u00e7\u00e3o em situa\u00e7\u00e3o de rua: maior vulnerabilidade e invisibilidade durante a pandemia de COVID-19","author":"Reinaldo MAS","year":"2020","edition":"2\u00aa ed"},{"issue":"3","key":"ref17","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/tmi.13720","article-title":"Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China","volume":"27","author":"Gilmour B","year":"2022","journal-title":"Trop Med Int Health"},{"issue":"3","key":"ref18","first-page":"360","article-title":"Factors associated with unsuccessful treatment outcome for tuberculosis in previously treated patients in Cali, Colombia, during the period 2015-2019","volume":"43","author":"Varela L","year":"2023","journal-title":"Biomedica"},{"issue":"6","key":"ref19","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1177\/00333549221148173","article-title":"Diagnosis, treatment, and prevention of tuberculosis among people experiencing homelessness in the United States: current recommendations","volume":"138","author":"Marks SM","year":"2023","journal-title":"Public Health Rep"},{"key":"ref20","series-title":"Manual de recomenda\u00e7\u00f5es para o controle da tuberculose no Brasil","year":"2019","edition":"2\u00aa ed"},{"key":"ref21","series-title":"Guia orientador: promo\u00e7\u00e3o da prote\u00e7\u00e3o social para as pessoas acometidas pela tuberculose","year":"2022"},{"key":"ref22","article-title":"Social protection for homeless individuals with tuberculosis from the perspective of Brazil\u2019s street clinic teams","author":"Pavinati G","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"ref23","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1590\/1413-81232022273.45132020","article-title":"Abandono do tratamento da tuberculose no Brasil, 2012-2018: tend\u00eancia e distribui\u00e7\u00e3o espa\u00e7o-temporal","volume":"27","author":"Soeiro VMS","year":"2022","journal-title":"Ci\u00eanc Sa\u00fade Colet"},{"key":"ref24","series-title":"Brasil Livre da Tuberculose: Plano Nacional pelo Fim da Tuberculose como Problema de Sa\u00fade P\u00fablica: estrat\u00e9gias para 2021-2025","year":"2021"},{"key":"ref25","series-title":"Objetivos de desenvolvimento sustent\u00e1vel no Brasil"},{"key":"ref26","first-page":"53","article-title":"Performance evaluation of tuberculosis control in Brazilian municipalities","volume":"56","author":"Pinto PFPS","year":"2022","journal-title":"Rev Sa\u00fade P\u00fablica"},{"key":"ref27","article-title":"Advisory teams on the streets: A nurse\u2019s experience report","volume":"56","author":"Alecrim TFA","year":"2022","journal-title":"Rev Esc Enferm USP"},{"key":"ref28","series-title":"Decreto n\u00ba 11.908, de 6 de fevereiro de 2024. Institui o Programa Brasil Saud\u00e1vel - Unir para Cuidar, e altera o Decreto n\u00ba 11.494, de 17 de abril de 2023, para dispor sobre o Comit\u00ea Interministerial para a Elimina\u00e7\u00e3o da Tuberculose e de Outras Doen\u00e7as Determinadas Socialmente - CIEDDS","year":"2024"}],"container-title":["Revista Brasileira de Epidemiologia"],"original-title":["Tend\u00eancias e clusters da interrup\u00e7\u00e3o do tratamento da tuberculose nas pessoas em situa\u00e7\u00e3o de rua no Brasil: influ\u00eancia de fatores individuais, sociais e program\u00e1ticos"],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S1415-790X2025000100437&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T13:21:35Z","timestamp":1754659295000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S1415-790X2025000100437&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":28,"alternative-id":["S1415-790X2025000100437"],"URL":"https:\/\/doi.org\/10.1590\/1980-549720250041","relation":{"is-translation-of":[{"id-type":"doi","id":"10.1590\/1980-549720250041.2","asserted-by":"subject"},{"id-type":"doi","id":"10.1590\/1980-549720250041.2","asserted-by":"object"}]},"ISSN":["1980-5497","1415-790X"],"issn-type":[{"value":"1980-5497","type":"electronic"},{"value":"1415-790X","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e250041"}}