ArticleBMC infectious diseases2025
TB/HIV co-infection in homelessness and factors associated with loss to follow-up of tuberculosis treatment: a retrospective cohort.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionIn Brazil, the homeless population is 56 times more likely to become ill with tuberculosis than the general population, plus co-infection with HIV, which further increases this risk, including unfavorable outcomes. São Paulo is a major urban center in the Global South with a large population of people experiencing homelessness, particularly those coinfected with HIV, which poses challenges to clinical care and municipal management. Although it represents a significant public health issue, it remains underexplored in scientific literature. Therefore, this study aims to identify factors associated with loss to follow-up in tuberculosis treatment among homeless co-infected with HIV in São Paulo, Brazil, between 2015 and 2023.
methodThis is a retrospective cohort of TB/HIV co-infection cases in the homeless population of the municipality of São Paulo, Brazil between 2015 and 2023. The data was obtained from the Information System for Diseases and Notification. Descriptive analysis was carried out to characterize the clinical and sociodemographic profile of notified cases and binary logistic regression to identify associated factors.
resultsThe results showed a reduction in the percentage of cures and an increase in the loss to follow-up of tuberculosis treatment in the homeless population. Loss to follow-up was associated with the absence of Directly Observed Treatment (ORa = 13.47; 95%CI = 6.17-29.42), positive Sputum smear result at diagnosis (ORa = 3.44; 95%CI = 1.53-7.71) and re-entry after loss to follow-up (ORa = 2.10; 95%CI = 1.12-3.96). The progressive performance of control sputum smear microscopies was considered a protective factor (ORa = 0.52; 95%CI = 0.44-0.61).
conclusionThe factors associated with the loss of tuberculosis follow-up among the homeless population living with HIV were: type of entry, diagnostic and control bacilloscopy and the use of Directly Observed Treatment, which are mainly derived from health care and the link with the user. Thus, strengthening services and specific supervision strategies, such as the Street Clinic, is essential for controlling TB/HIV co-infection in this population.
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