Spatiotemporal trends in and challenges of addressing tuberculosis in Brazil before and after the COVID-19 pandemic, 2001–2023

Objective: To identify spatiotemporal patterns and clusters of tuberculosis (TB) in Brazil between 2001 and 2023, assess the impact of the COVID-19 pandemic on TB trends, and provide recommendations for targeted interventions. Methods: This ecological study analyzed secondary data from Brazil's Notifiable Diseases Information System (known as SINAN), which covers all confirmed TB cases during the study period. Three main indicators were analyzed: TB incidence and two treatment outcomes - cure and loss to follow up. Spatiotemporal cluster analysis was conducted using the Emerging Hot Spot Analysis tool in ArcGIS Pro 2.8 (Esri, Redlands, CA, USA), based on the Getis-Ord Gi* statistic. Results: An average of 74 057 TB cases were reported annually. TB incidence declined until 2016 but increased afterward, peaking in 2023. Cure rates declined after 2016, especially following the COVID-19 pandemic, while the rates of loss to follow up increased. Hot spots for incidence and loss to follow up were concentrated in the North, Southeast, and Central-West regions. The South region showed cold spots for cure and loss to follow up. These spatial trends revealed persistent regional disparities in TB outcomes that are closely related to indicators associated with socioeconomic status and access to health care. Conclusions: TB continues to present critical public health challenges in Brazil, particularly since the COVID-19 pandemic. Spatiotemporal analysis revealed significant regional clusters of TB burden. Strengthening surveillance systems and improving early diagnosis and treatment adherence strategies, especially in high-burden regions, are essential to mitigate the post-pandemic resurgence of TB and to achieve the World Health Organization's goal of eliminating TB by 2035.