Scaling Up Tuberculosis Preventive Treatment in the Brazilian Amazon (2016-2024): a Programmatic Report on Multi-sector Integration in Surveillance, Health Services and Academia

BACKGROUND: Tuberculosis (TB) remains a major public health challenge in Brazil, particularly in the state of Amazonas, where geographic, socioeconomic, and health system barriers hinder the implementation of TB preventive treatment (TPT). This study describes the scale-up of TPT, supported by integrated actions across surveillance, health services, and academia in this high-burden setting. METHODS: We conducted a retrospective implementation analysis of TPT in Amazonas, Brazil (2016-2024), using data from the IL-TB system, SINAN-TB, and HIV/AIDS Clinical Monitoring Panel. A structured set of indicators was used to assess TPT delivery, decentralization, diagnostic practices, regimen uptake, and treatment outcomes. Proportions and rates were estimated with 95% confidence intervals (95% CI). RESULTS: A total of 8,120 individuals initiated TPT, including 5,001 TB contacts, whereas more than 70,000 contacts were recorded in the SINAN-TB. Following the IL-TB implementation in 2019, the indicators showed a sustained expansion of TPT delivery. By 2024, TPT initiation among contacts reached 18.4% (95% CI: 17.6-19.3), and 959 PLHIV initiated TPT, corresponding to 441.33 per 1,000 antiretroviral therapy. The proportion of TPT initiation in primary health care increased from 19.3% (95% CI: 13.8-26.4) in 2018 to 55.2% (95% CI: 53.3-57.1) in 2024. Use of 3HP (weekly rifapentine plus isoniazid for three months) rose from 12.7% (95% CI: 10.6-15.1) in 2021 to 93.3% (95% CI: 92.3-94.2) in 2024. Completion reached 84.8% (95% CI: 82.9-86.6) and remained above 80% thereafter. CONCLUSIONS: TPT scale-up in Amazonas was accompanied by expanded access, greater decentralization, and rapid adoption of shortened regimens, although important coverage gaps among priority populations remain.