Os transtornos mentais e o uso de substâncias psicoativas e sua relação com a perda de seguimento do tratamento de tuberculose

Abstract

Introduction: Tuberculosis is a treatable and potentially curable infectious and communicable disease; however, it remains one of the infectious diseases with the highest mortality rates worldwide. Active tuberculosis is associated with individual vulnerabilities, and addressing the disease requires consideration of psychoactive substance use and mental disorders, which share common risk factors for the development of active tuberculosis and may influence treatment nonadherence. Objective: To identify factors associated with loss to follow-up during tuberculosis treatment among people who use psychoactive substances or have a mental disorder in Brazil, 2013–2023. Method: This was a quantitative, cross-sectional epidemiological study using secondary data provided by the Ministry of Health through the Notifiable Diseases Information System (SINAN). Pearson's chi-square test and corresponding standardized residuals were used, at a 5% significance level, to identify associations based on an excess of occurrences. Results: A total of 771,922 new tuberculosis cases reported in Brazil were analyzed. Overall, psychoactive substance use and the presence of mental disorders accounted for 49.4% of these notifications. Significant associations were found between loss to follow-up during tuberculosis treatment and the use of alcohol, tobacco, or illicit drugs, as well as the presence of mental disorders, whereas no association was found with the cure outcome. Among reported cases of loss to follow-up during tuberculosis treatment, psychoactive substance use was associated with male sex, up to 12 years of schooling, and smear-positive pulmonary tuberculosis. Psychoactive substance use and the presence of mental disorders were associated with Black or Brown race/ethnicity, HIV/AIDS, failure to undergo Directly Observed Treatment (DOT), homelessness, and the pulmonary clinical form of tuberculosis. Conclusion: Psychoactive substance use and the presence of mental disorders are factors associated with loss to follow-up during tuberculosis treatment in Brazil. Furthermore, these conditions are associated with other unfavorable outcomes, such as death from tuberculosis or other causes, the development of drug-resistant tuberculosis, treatment failure, and the need to change the medication regimen. The high proportion of cases involving psychoactive substance use or mental disorders highlights the need to adapt tuberculosis control programs to address these factors and reduce loss to follow-up during tuberculosis treatment.