Tuberculose na população privada de liberdade e em liberdade: perfil epidemiológico e análise diagnóstica em Governador Valadares (MG) no período de 2014 a 2023

Abstract

Tuberculosis remains a major public health challenge, disproportionately affecting populations living in conditions of high social vulnerability, particularly within prison systems. This dissertation aimed to analyse the epidemiological and diagnostic profile of tuberculosis, as well as to evaluate the burden of morbidity and mortality and the factors associated with treatment outcomes among the incarcerated and non-incarcerated populations in Governador Valadares, Minas Gerais, Brazil, from 2014 to 2023. This retrospective, cross-sectional, quantitative study was based on secondary data obtained from the Brazilian Notifiable Diseases Information System (Sinan), made available by the Regional Health Superintendence of Governador Valadares. Individuals residing in the municipality at the time of diagnosis were included and classified as incarcerated or non-incarcerated. Retreatment cases, transfer-in cases, records with unknown type of entry, and cases closed due to a change in diagnosis were excluded. Results showed a higher risk of developing tuberculosis among the incarcerated population throughout the study period. Pulmonary disease predominated in young adults, highlighting the prison system as a strategic setting for sustaining transmission. Differences according to sex, race/skin colour, and educational attainment confirmed the persistence of social inequities. In adjusted analyses, clinical and behavioural factors were associated with treatment outcomes, including HIV coinfection, illicit drug use, smoking, diabetes, older age, and more complex clinical forms. The higher probability of cure and the lower likelihood of treatment interruption among the incarcerated population reflected organisational aspects of custody. Regarding diagnosis, the introduction of the rapid molecular test for tuberculosis (TRM-TB) expanded operational coverage, particularly among the incarcerated population. The lower positivity of smear microscopy and culture compared with TRM-TB reinforced the central role of molecular testing. The high frequency of chest radiographic findings suggestive of tuberculosis (90.3%) highlighted its complementary value in case detection. Tuberculosis in Governador Valadares remains strongly shaped by structural inequalities, with the incarcerated population experiencing a markedly higher risk of disease. The magnitude of this disparity reinforces incarceration as a central social determinant of tuberculosis in the municipality, with effects extending beyond prison walls and influencing disease dynamics in the wider community. Sustained reductions in the burden of tuberculosis require integrated structural strategies linking the prison system and the broader health-care network.