TUBERCULOSIS IN BRAZIL: CHALLENGES AND INEQUALITIES

In 2022, Brazil recorded 73,000 new cases of tuberculosis (rate of 34.1 per 100,000 inhabitants), consolidating it as the fifth leading cause of death from infectious diseases in the country. The COVID-19 pandemic worsened underreporting, with a 15% decrease in detection (2020–2021). In 2021, mortality reached 2.4 deaths per 100,000 inhabitants, totaling 4,500 deaths per year, with high lethality among vulnerable groups. People experiencing homelessness have a tenfold higher risk. People living with HIV account for 20% of cases. Patients with diabetes showed a threefold higher risk. The search was conducted in the PubMed, ScienceDirect, and LILACS databases between April and May 2025, using descriptors according to DeCS and associated MeSH (Medical Subject Headings) terminology, ensuring a systematic and comprehensive approach with the terms “tuberculosis statistic”, “tuberculosis Brazil”, “tuberculosis treatment”, and “tuberculosis human”. Filters were applied to include articles with full text and free access, published in the last five years. The search yielded 75 articles, and 52 were selected after title screening. Abstract reading subsequently led to the exclusion of 11 articles that did not meet the established criteria, such as correlating more than one pathology; data from other countries; serotherapy and related topics; addressing pathological mechanisms; non-human samples; and describing therapeutic strategies for tuberculosis. In the end, 12 articles were included in this review. Sixty percent of cases are concentrated in 40% of the poorest municipalities, with emphasis on the state of Amazonas (57.2 per 100,000) and Rio de Janeiro (46.5 per 100,000). In the incarcerated population, the rate is 35 times higher than the national average. Eight to twelve percent of cases have HIV coinfection. Drug-resistant TB accounts for 1.3% of new cases and 7.8% of retreatment cases (in Rio de Janeiro, up to 3.5%). The pandemic caused an 18% reduction in diagnoses (2020–2021) and 30% delays in treatment. Advances include rapid molecular tests (GeneXpert), which increased detection by 25%. Eighty-five percent initiate therapy, but 20% abandon treatment. Under the national plan to end TB, the goal is to reduce incidence to less than 10 per 100,000 by 2035. Tuberculosis remains a serious public health problem, marked by social and regional inequalities. Integrated strategies such as active case finding, management of comorbidities, and reduction of treatment abandonment are urgent to achieve WHO targets.