Author:

• Gabriel Pavinati - Pavinati, G. - <gabrielpavinati00@gmail.com>
ORCID: https://orcid.org/0000-0002-0289-8219

Co-author(s):

• Lucas Vinícius de Lima - Lima, L. V. - <lvl.vinicius@gmail.com>
ORCID: https://orcid.org/0000-0002-9582-9641
• Camila Silveira Silva Teixeira - Teixeira, C. S. S. - <csst.camila@gmail.com>
ORCID: https://orcid.org/0000-0001-6340-7957
• Paula Hino - Hino, P. - <paula.hino@unifesp.br>
ORCID: https://orcid.org/0000-0002-1408-196X
• Maria Rita Bertolozzi - Bertolozzi, M.R. - <mrbertol@usp.br>
ORCID: https://orcid.org/0000-0002-5009-5285
• Joilda Silva Nery - Nery, J. S. - <joildanery@gmail.com>
ORCID: https://orcid.org/0000-0002-1576-6418
• Gabriela Tavares Magnabosco - Magnabosco, G. T. - <gtmagnabosco@uem.br>
ORCID: https://orcid.org/0000-0003-3318-6748

Abstract:

This retrospective cohort identified factors associated with loss to follow-up and death due to tuberculosis in the homeless population in Brazil, estimating odds ratios (OR) and their 95% confidence intervals (95%CI) by multinomial logistic regression. A total of 3,831 tuberculosis cases in this population were analyzed, of which 57.0% had unfavorable outcomes. Loss to follow-up was associated with: history of abandonment (OR = 2.38; 95%CI 2.05–2.77), unknown HIV serology (OR = 1.79; 95%CI 1.38–2.32), HIV coinfection (OR = 1.73; 95%CI 1.46–2.06), drug use (OR = 1.54; 95%CI 1.31–1.80), age (OR = 0.98; 95%CI 0.97–0.99), mixed clinical form (OR = 0.64; 95%CI 0.42–0.97), extrapulmonary form (OR = 0.46; 95%CI 0.29–0.73), government program assistance (OR = 0.64; 95%CI 0.50–0.81), and supervised treatment (OR = 0.52; 95%CI 0.45–0.60). Regarding death, the following were associated: age (OR = 1.03; 95%CI 1.01–1.05), unknown HIV serology (OR = 2.39; 95%CI 1.48–3.86), alcohol use (OR = 1.81; 95%CI 1.27–2.58), and supervised treatment (OR = 0.70; 95%CI 0.51–0.96). Overlapping vulnerabilities in the health-disease process of homeless people with tuberculosis were observed, requiring comprehensive and cross-sectoral care practices.

Keywords:

Homeless people. Health Inequities. Tuberculosis. Cohort Studies.

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