DRUG-RESISTANT TUBERCULOSIS IN BRAZIL (2013–2023): AN INTEGRATED ANALYSIS OF SURVEILLANCE AND MORBIDITY AND MORTALITY USING SIT-TB AND DATASUS DATA

Drug-resistant tuberculosis represents one of the main challenges for disease control in Brazil. Cases of multidrug-resistant tuberculosis (TB-MDR) and extensively drug-resistant tuberculosis (TB-XDR) increase treatment duration, costs, and the risk of unfavorable outcomes. This study aims to analyze the evolution and impact of drug-resistant tuberculosis in Brazil (2013–2023), based on surveillance and healthcare data. Descriptive, retrospective epidemiological study using secondary data. Tuberculosis epidemiological bulletins published by the Ministry of Health (SIT-TB data) and DATASUS/Tabnet data (SIH-SUS and SIM) were analyzed. The evolution of TB-MDR/XDR cases from 2013 to 2023 was assessed, including distribution by region, sex, and age group, as well as hospitalization and tuberculosis mortality rates (ICD A15–A19). Data were presented as absolute values, proportions, and temporal trends. Comparability criteria between years were respected, considering the standardization of SIT-TB from 2013 onward. Between 2013 and 2023, Brazil reported more than 13,000 cases of drug-resistant tuberculosis, with progressive growth until 2019. Most TB-MDR cases were concentrated in the Southeast and South regions, mainly among men aged 20 to 49 years. The 2024 bulletin revealed that only 66.5% of TB-MDR cases initiated appropriate treatment and that 17.1% progressed to treatment abandonment. In the same period, DATASUS recorded approximately 130,000 hospitalizations for tuberculosis, with an average in-hospital fatality rate of 3.5%. The states with the highest mortality rates coincided with those concentrating the highest number of resistant cases. An upward trend in hospitalizations for drug-resistant TB was observed between 2013 and 2019, with fluctuating declines in subsequent years. The combination of SIT-TB and DATASUS data allowed identification of the persistence and complexity of drug-resistant tuberculosis in Brazil over the last decade. The low rate of treatment initiation and adherence in TB-MDR cases reinforces the urgency of public policies aimed at expanding early diagnosis, resistance testing, and treatment surveillance. Integrated strategies between surveillance and healthcare services are essential to contain the advance of resistance and reduce associated morbidity and mortality.