Abstract This retrospective cohort study identified factors associated with loss of follow-up and death due to tuberculosis (TB) in the homeless population (HP) in Brazil, estimating odds ratios (OR) and their 95% confidence intervals (95%CI) by multinomial logistic regression. A total of 3,831 TB cases in this population were analyzed, of which 57.0% had unfavorable outcomes. Loss of 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 beneficiary (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 consumption (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 individuals with TB were observed, requiring comprehensive and cross-sectoral care practices. followup follow up (TB HP (HP Brazil OR (OR 95 95CI CI (95%CI regression 3831 3 831 3,83 analyzed 570 57 0 57.0 outcomes OR=2.38 OR238 2 38 (OR=2.38 2.052.77, 205277 2.05 2.77 , 05 77 2.05-2.77) OR=1.79 OR179 1 79 (OR=1.79 1.382.32, 138232 1.38 2.32 32 1.38-2.32) OR=1.73 OR173 73 (OR=1.73 1.462.06, 146206 1.46 2.06 46 06 1.46-2.06) OR=1.54 OR154 54 (OR=1.54 1.311.80, 131180 1.31 1.80 31 80 1.31-1.80) OR=0.98 OR098 98 (OR=0.98 0.970.99, 097099 0.97 0.99 97 99 0.97-0.99) OR=0.64 OR064 64 (OR=0.64 0.420.97, 042097 0.42 42 0.42-0.97) OR=0.46 OR046 (OR=0.46 0.290.73, 029073 0.29 0.73 29 0.29-0.73) 0.500.81, 050081 0.50 0.81 50 81 0.50-0.81) OR=0.52 OR052 52 (OR=0.52 0.450.60. 045060 0.45 0.60 . 45 60 0.45-0.60) OR=1.03 OR103 03 (OR=1.03 1.011.05, 101105 1.01 1.05 01 1.01-1.05) OR=2.39 OR239 39 (OR=2.39 1.483.86, 148386 1.48 3.86 48 86 1.48-3.86) OR=1.81 OR181 (OR=1.81 1.272.58, 127258 1.27 2.58 27 58 1.27-2.58) OR=0.70 OR070 70 (OR=0.70 0.510.96. 051096 0.51 0.96 51 96 0.51-0.96) healthdisease health disease observed crosssectoral cross sectoral practices 9 383 83 3,8 5 57. OR=2.3 OR23 (OR=2.3 052 2.052.77 20527 205 2.0 277 2.7 7 2.05-2.77 OR=1.7 OR17 (OR=1.7 382 1.382.32 13823 138 1.3 232 2.3 1.38-2.32 462 1.462.06 14620 146 1.4 206 4 1.46-2.06 OR=1.5 OR15 (OR=1.5 311 1.311.80 13118 131 180 1.8 8 1.31-1.80 OR=0.9 OR09 (OR=0.9 970 0.970.99 09709 097 0.9 099 0.97-0.99 OR=0.6 OR06 6 (OR=0.6 420 0.420.97 04209 042 0.4 0.42-0.97 OR=0.4 OR04 (OR=0.4 290 0.290.73 02907 029 0.2 073 0.7 0.29-0.73 500 0.500.81 05008 050 0.5 081 0.8 0.50-0.81 OR=0.5 OR05 (OR=0.5 450 0.450.60 04506 045 060 0.6 0.45-0.60 OR=1.0 OR10 (OR=1.0 011 1.011.05 10110 101 1.0 105 1.01-1.05 483 1.483.86 14838 148 386 3.8 1.48-3.86 OR=1.8 OR18 (OR=1.8 272 1.272.58 12725 127 1.2 258 2.5 1.27-2.58 OR=0.7 OR07 (OR=0.7 510 0.510.96 05109 051 096 0.51-0.96 3, OR=2. OR2 (OR=2. 2.052.7 2052 20 2. 2.05-2.7 OR=1. OR1 (OR=1. 1.382.3 1382 13 1. 23 1.38-2.3 1.462.0 1462 14 1.46-2.0 1.311.8 1311 18 1.31-1.8 OR=0. OR0 (OR=0. 0.970.9 0970 09 0. 0.97-0.9 0.420.9 0420 04 0.42-0.9 0.290.7 0290 02 07 0.29-0.7 0.500.8 0500 08 0.50-0.8 0.450.6 0450 0.45-0.6 1.011.0 1011 10 1.01-1.0 1.483.8 1483 3. 1.48-3.8 1.272.5 1272 12 25 1.27-2.5 0.510.9 0510 0.51-0.9 OR=2 (OR=2 2.052. 2.05-2. OR=1 (OR=1 1.382. 1.38-2. 1.462. 1.46-2. 1.311. 1.31-1. OR=0 (OR=0 0.970. 0.97-0. 0.420. 0.42-0. 0.290. 0.29-0. 0.500. 0.50-0. 0.450. 0.45-0. 1.011. 1.01-1. 1.483. 1.48-3. 1.272. 1.27-2. 0.510. 0.51-0. OR= (OR= 2.052 2.05-2 1.382 1.38-2 1.462 1.46-2 1.311 1.31-1 0.970 0.97-0 0.420 0.42-0 0.290 0.29-0 0.500 0.50-0 0.450 0.45-0 1.011 1.01-1 1.483 1.48-3 1.272 1.27-2 0.510 0.51-0 2.05- 1.38- 1.46- 1.31- 0.97- 0.42- 0.29- 0.50- 0.45- 1.01- 1.48- 1.27- 0.51-
Resumo Esta coorte retrospectiva identificou os fatores associados à perda de seguimento e ao óbito por tuberculose na população em situação de rua no Brasil, estimando-se as odds ratios (OR) e seus intervalos de confiança de 95% (IC95%) por regressão logística multinominal. Analisaram-se 3.831 casos de tuberculose nessa população, dos quais 57,0% tiveram desfechos desfavoráveis. Associaram-se à perda de seguimento: histórico de abandono (OR=2,38; IC95% 2,05-2,77), desconhecimento da sorologia do HIV (OR=1,79; IC95% 1,38-2,32) e coinfecção com HIV (OR=1,73; IC95% 1,46-2,06), uso de drogas (OR=1,54; IC95% 1,31-1,80), idade (OR=0,98; IC95% 0,97-0,99), forma clínica mista (OR=0,64; IC95% 0,42-0,97) e extrapulmonar (OR=0,46; IC95% 0,29-0,73), auxílio de programa governamental (OR=0,64; IC95% 0,50-0,81) e tratamento supervisionado (OR=0,52; IC95% 0,45-0,60). Em relação ao óbito, associaram-se: idade (OR=1,03; IC95% 1,01-1,05), desconhecimento da sorologia do HIV (OR=2,39; IC95% 1,48-3,86), uso de álcool (OR=1,81; IC95% 1,27-2,58) e tratamento supervisionado (OR=0,70; IC95% 0,51-0,96). Percebeu-se a sobreposição de vulnerabilidades no processo saúde-doença das pessoas em situação de rua com tuberculose, demandando práticas cuidativas intersetoriais e integrais. Brasil estimandose estimando se OR (OR 95 IC95 IC (IC95% multinominal Analisaramse Analisaram 3831 3 831 3.83 570 57 0 57,0 desfavoráveis Associaramse Associaram OR=2,38 OR238 2 38 (OR=2,38 2,052,77, 205277 2,05 2,77 , 05 77 2,05-2,77) OR=1,79 OR179 1 79 (OR=1,79 1,382,32 138232 1,38 2,32 32 1,38-2,32 OR=1,73 OR173 73 (OR=1,73 1,462,06, 146206 1,46 2,06 46 06 1,46-2,06) OR=1,54 OR154 54 (OR=1,54 1,311,80, 131180 1,31 1,80 31 80 1,31-1,80) OR=0,98 OR098 98 (OR=0,98 0,970,99, 097099 0,97 0,99 97 99 0,97-0,99) OR=0,64 OR064 64 (OR=0,64 0,420,97 042097 0,42 42 0,42-0,97 OR=0,46 OR046 (OR=0,46 0,290,73, 029073 0,29 0,73 29 0,29-0,73) 0,500,81 050081 0,50 0,81 50 81 0,50-0,81 OR=0,52 OR052 52 (OR=0,52 0,450,60. 045060 0,45 0,60 . 45 60 0,45-0,60) associaramse associaram associaram-se OR=1,03 OR103 03 (OR=1,03 1,011,05, 101105 1,01 1,05 01 1,01-1,05) OR=2,39 OR239 39 (OR=2,39 1,483,86, 148386 1,48 3,86 48 86 1,48-3,86) OR=1,81 OR181 (OR=1,81 1,272,58 127258 1,27 2,58 27 58 1,27-2,58 OR=0,70 OR070 70 (OR=0,70 0,510,96. 051096 0,51 0,96 51 96 0,51-0,96) Percebeuse Percebeu saúdedoença saúde doença integrais 9 IC9 (IC95 383 83 3.8 5 57, OR=2,3 OR23 (OR=2,3 052 2,052,77 20527 205 2,0 277 2,7 7 2,05-2,77 OR=1,7 OR17 (OR=1,7 382 1,382,3 13823 138 1,3 232 2,3 1,38-2,3 462 1,462,06 14620 146 1,4 206 4 1,46-2,06 OR=1,5 OR15 (OR=1,5 311 1,311,80 13118 131 180 1,8 8 1,31-1,80 OR=0,9 OR09 (OR=0,9 970 0,970,99 09709 097 0,9 099 0,97-0,99 OR=0,6 OR06 6 (OR=0,6 420 0,420,9 04209 042 0,4 0,42-0,9 OR=0,4 OR04 (OR=0,4 290 0,290,73 02907 029 0,2 073 0,7 0,29-0,73 500 0,500,8 05008 050 0,5 081 0,8 0,50-0,8 OR=0,5 OR05 (OR=0,5 450 0,450,60 04506 045 060 0,6 0,45-0,60 OR=1,0 OR10 (OR=1,0 011 1,011,05 10110 101 1,0 105 1,01-1,05 483 1,483,86 14838 148 386 3,8 1,48-3,86 OR=1,8 OR18 (OR=1,8 272 1,272,5 12725 127 1,2 258 2,5 1,27-2,5 OR=0,7 OR07 (OR=0,7 510 0,510,96 05109 051 096 0,51-0,96 (IC9 3. OR=2, OR2 (OR=2, 2,052,7 2052 20 2, 2,05-2,7 OR=1, OR1 (OR=1, 1,382, 1382 13 1, 23 1,38-2, 1,462,0 1462 14 1,46-2,0 1,311,8 1311 18 1,31-1,8 OR=0, OR0 (OR=0, 0,970,9 0970 09 0, 0,97-0,9 0,420, 0420 04 0,42-0, 0,290,7 0290 02 07 0,29-0,7 0,500, 0500 08 0,50-0, 0,450,6 0450 0,45-0,6 1,011,0 1011 10 1,01-1,0 1,483,8 1483 3, 1,48-3,8 1,272, 1272 12 25 1,27-2, 0,510,9 0510 0,51-0,9 (IC OR=2 (OR=2 2,052, 2,05-2, OR=1 (OR=1 1,382 1,38-2 1,462, 1,46-2, 1,311, 1,31-1, OR=0 (OR=0 0,970, 0,97-0, 0,420 0,42-0 0,290, 0,29-0, 0,500 0,50-0 0,450, 0,45-0, 1,011, 1,01-1, 1,483, 1,48-3, 1,272 1,27-2 0,510, 0,51-0, OR= (OR= 2,052 2,05-2 1,38- 1,462 1,46-2 1,311 1,31-1 0,970 0,97-0 0,42- 0,290 0,29-0 0,50- 0,450 0,45-0 1,011 1,01-1 1,483 1,48-3 1,27- 0,510 0,51-0 2,05- 1,46- 1,31- 0,97- 0,29- 0,45- 1,01- 1,48- 0,51-