{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T13:05:05Z","timestamp":1772197505383,"version":"3.50.1"},"reference-count":34,"publisher":"Pan American Health Organization","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,27]]},"abstract":"<title>ABSTRACT<\/title>\n                  <sec>\n                    <title>Objective.<\/title>\n                    <p>To identify spatiotemporal patterns and clusters of tuberculosis (TB) in Brazil between 2001 and 2023, assess the impact of the COVID-19 pandemic on TB trends, and provide recommendations for targeted interventions.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Methods.<\/title>\n                    <p>This ecological study analyzed secondary data from Brazil\u2019s Notifiable Diseases Information System (known as SINAN), which covers all confirmed TB cases during the study period. Three main indicators were analyzed: TB incidence and two treatment outcomes \u2013 cure and loss to follow up. Spatiotemporal cluster analysis was conducted using the Emerging Hot Spot Analysis tool in ArcGIS Pro 2.8 (Esri, Redlands, CA, USA), based on the Getis-Ord Gi* statistic.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Results.<\/title>\n                    <p>An average of 74 057 TB cases were reported annually. TB incidence declined until 2016 but increased afterward, peaking in 2023. Cure rates declined after 2016, especially following the COVID-19 pandemic, while the rates of loss to follow up increased. Hot spots for incidence and loss to follow up were concentrated in the North, Southeast, and Central\u2013West regions. The South region showed cold spots for cure and loss to follow up. These spatial trends revealed persistent regional disparities in TB outcomes that are closely related to indicators associated with socioeconomic status and access to health care.<\/p>\n                  <\/sec>\n                  <sec>\n                    <title>Conclusions.<\/title>\n                    <p>TB continues to present critical public health challenges in Brazil, particularly since the COVID-19 pandemic. Spatiotemporal analysis revealed significant regional clusters of TB burden. Strengthening surveillance systems and improving early diagnosis and treatment adherence strategies, especially in high-burden regions, are essential to mitigate the post-pandemic resurgence of TB and to achieve the World Health Organization\u2019s goal of eliminating TB by 2035.<\/p>\n                  <\/sec>","DOI":"10.26633\/rpsp.2026.10","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T12:21:40Z","timestamp":1772194900000},"page":"1","source":"Crossref","is-referenced-by-count":0,"title":["Spatiotemporal trends in and challenges of addressing tuberculosis in Brazil before and after the COVID-19 pandemic, 2001\u20132023"],"prefix":"10.26633","volume":"50","author":[{"given":"Daiane Alves","family":"da Silva","sequence":"first","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-2840-3798"},{"name":"Universidade Estadual de Maring\u00e1, Maring\u00e1, Paran\u00e1, Brazil"},{"name":"enfvigilancia@gmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"de Macedo Couto","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0003-2598-5830"},{"name":"Universidade Estadual de Maring\u00e1, Maring\u00e1, Paran\u00e1, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Layana Costa","family":"Alves","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0003-3512-7872"},{"name":"Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o-Geral de Vigil\u00e2ncia da Tuberculose, Micoses End\u00eamicas e Micobact\u00e9rias n\u00e3o Tuberculosas\/DAET\/SVS\/MS, Bras\u00edlia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Vitor Perez","family":"de Souza","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0003-4863-0071"},{"name":"Universidade Estadual de Maring\u00e1, Maring\u00e1, Paran\u00e1, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kleydson Bonfim Andrade","family":"Alves","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-0905-3358"},{"name":"Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o-Geral de Vigil\u00e2ncia da Tuberculose, Micoses End\u00eamicas e Micobact\u00e9rias n\u00e3o Tuberculosas\/DAET\/SVS\/MS, Bras\u00edlia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patr\u00edcia","family":"Bartholomay","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-4881-0630"},{"name":"Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o-Geral de Vigil\u00e2ncia da Tuberculose, Micoses End\u00eamicas e Micobact\u00e9rias n\u00e3o Tuberculosas\/DAET\/SVS\/MS, Bras\u00edlia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghabriela","family":"Boitrago","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-3710-6437"},{"name":"Universidade Federal de Bras\u00edlia, Bras\u00edlia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N\u00fabia Cristina","family":"da Silva","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0003-4422-974X"},{"name":"Cons\u00f3rcio M\u00e9todos Anal\u00edticos e Tecnologia para Sa\u00fade (MATH), Belo Horizonte, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda Dockhorn","family":"Costa","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-1762-9484"},{"name":"Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o-Geral de Vigil\u00e2ncia da Tuberculose, Micoses End\u00eamicas e Micobact\u00e9rias n\u00e3o Tuberculosas\/DAET\/SVS\/MS, Bras\u00edlia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerson Fernando","family":"Pereira","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0001-8886-1662"},{"name":"Minist\u00e9rio da Sa\u00fade, Secretaria de Vigil\u00e2ncia em Sa\u00fade, Coordena\u00e7\u00e3o-Geral de Vigil\u00e2ncia da Tuberculose, Micoses End\u00eamicas e Micobact\u00e9rias n\u00e3o Tuberculosas\/DAET\/SVS\/MS, Bras\u00edlia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Staton","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-6468-2894"},{"name":"Duke Global Health Institute, Duke University, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Ricardo Nickenig","family":"Vissoci","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0001-7276-0402"},{"name":"Duke Global Health Institute, Duke University, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thiago Augusto Hernandes","family":"Rocha","sequence":"additional","affiliation":[{"name":"https:\/\/orcid.org\/0000-0002-6262-3276"},{"name":"Duke Global Health Institute, Duke University, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"11167","reference":[{"key":"ref1","unstructured":"World Health Organization. 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