IMPACT OF THE COVID-19 PANDEMIC ON TUBERCULOSIS HOSPITALIZATIONS IN A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL: EPIDEMIOLOGICAL AND CLINICAL ANALYSIS BETWEEN 2018 AND 2022

Tuberculosis (TB) remains a major public health challenge in Brazil, with the state of Rio Grande do Sul showing high incidence, especially among people living with HIV (PLHIV). The COVID-19 pandemic worsened this scenario by overburdening health services and hindering outpatient follow-up of chronic conditions, including TB. This study aimed to describe the epidemiological and clinical profile of patients hospitalized for TB in a hospital in the metropolitan region of Porto Alegre between 2018 and 2022, with emphasis on changes observed during the pandemic. Cross-sectional, retrospective study using secondary data provided by the Hospital Epidemiology Center of a university hospital. Patients aged 18 years or older with confirmed TB diagnosis and hospitalization between January 2018 and December 2022 were included. Variables analyzed included sex, ethnicity, age, comorbidities, clinical forms of TB, diagnostic methods, length of hospital stay, treatment instituted, and hospital outcome. Pre-pandemic (2018–2019) and pandemic (2020–2022) periods were compared using descriptive statistics. A total of 224 TB cases were recorded between 2018 and 2022, of which 130 were hospitalized and included in the analysis. Most were male (67.7%), white (66.2%), with a mean age of 45 years. The main comorbidities were HIV (33.8%), AIDS (30%), and mental disorders (29.2%), in addition to high rates of smoking (59.2%) and illicit drug use (33.1%). There was a marked increase in new cases during the pandemic (mean of 23.7 per year between 2020–2022, compared to only 4 new cases between 2018–2019). Pulmonary TB was the most frequent form (82.3%), with 65.4% smear-positive cases and 11.5% also presenting extrapulmonary forms. The rapid molecular test was the main diagnostic method; no cases of multidrug-resistant TB were identified. The mean length of hospitalization increased from 21.5 days (pre-pandemic) to 28.8 days (pandemic). Most patients-initiated treatment with the 2RHZE/4RH regimen. Mortality ranged from 17.2% to 29.5%, with the worst rate observed in 2021. The COVID-19 pandemic significantly impacted the profile of TB hospitalizations, with increased number of cases, longer hospital stays, and high mortality. Reduced access to primary health care may have contributed to more severe clinical presentations, in addition to the possibility that hospitalization for COVID-19 led to incidental diagnosis of TB in some patients.