EXPERIENCE WITH TUBERCULOSIS TREATMENT ADHERENCE IN THE POPULATION OF PONTAL, SP

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a globally significant infectious disease, with high mortality and challenges related to drug resistance (MDR/XDR-TB) and treatment adherence. Airborne transmission, latent infection, and social determinants, especially in vulnerable groups such as older adults and immunocompromised individuals, worsen disease control. In Brazil, the situation was further compromised during the COVID-19 pandemic, negatively affecting access to diagnosis, treatment adherence, and clinical outcomes. In this context, this study aimed to describe the epidemiology of TB in the municipality of Pontal (São Paulo), between 2018 and 2023, assessing the pandemic’s impact on treatment adherence and the locally adopted strategies to strengthen continuity of care. Observational, longitudinal, retrospective study based on analysis of data from the TB-WEB system. Descriptive and comparative statistics were used to evaluate indicators such as cure, treatment abandonment, death, transfer, and adherence strategies for TB treatment. A review of the national and international literature complemented the critical analysis of challenges faced in TB control. In 2018, Pontal recorded a 79% cure rate, exceeding the national (73%) and global (71%) averages. During the pandemic, cure rates decreased to 54% in 2019, 50% in 2020, and 52% in 2021, with increased abandonment rates (36% in 2019, 31.5% in 2020, and 21% in 2021). In 2022, with the resumption of health services, there was partial recovery (70% cure and 11% abandonment), but in 2023 the cure rate fell again to 36%, reflecting the prolonged effects of the pandemic and structural challenges in treatment adherence. To address this scenario, the municipality adopted strategies such as Directly Observed Therapy (DOT), use of the WebDOT application for remote monitoring of adherence, intensified work by community health agents, specialized technical support, and educational actions supported by an academic infectious diseases league. The pandemic worsened discontinuity of TB treatment. The partial recovery in 2022 reinforces the importance of strategies such as Directly Observed Therapy (DOT), strengthening Primary Health Care, and social support. Resilient and decentralized public policies are essential to ensure continuity of treatment and mitigate the impacts of tuberculosis.