Identification of risk areas and associated factors of unfavorable treatment outcomes in drug-resistant tuberculosis: Evidence from Rio de Janeiro, Brazil

Drug-resistant tuberculosis remains a major challenge to tuberculosis control in Brazil and worldwide. OBJECTIVE: To identify factors associated with unfavorable treatment outcomes and to analyze the occurrence of high-risk spatial clusters at an intra-urban scale in the municipality of Rio de Janeiro, Brazil. METHODS: A retrospective cohort study of drug-resistant tuberculosis cases reported between 2015 and 2022 was conducted. Individual-level and spatial analyses were performed to identify associated factors with unfavorable outcomes and high-risk clusters. RESULTS: Of the 972 cases analyzed, 31.6% had unfavorable outcomes, including 20.2% lost to follow-up, 4.9% with treatment failure, and 6.3% deaths. Loss to follow-up was higher among males, Black individuals, those with low education levels, individuals with AIDS, and those who used alcohol, tobacco, or illicit drugs, whereas older age and diabetes were associated with lower odds. Treatment failure was more frequent among individuals of Brown race/skin color, those with multidrug-resistant and extensively drug-resistant tuberculosis, and those with multiple previous treatments. Mortality was higher among individuals over 40 years of age, those with multidrug-resistant and extensively drug-resistant tuberculosis, those with alcohol use, and individuals AIDS. Three high-risk spatial clusters were identified in the northern zone of the city, an area of marked social vulnerability. CONCLUSION: Unfavorable drug-resistant tuberculosis outcomes are influenced by socioeconomic factors, particularly in socially vulnerable urban areas. In this context, strengthening local surveillance in identified high-risk clusters, improving patient-centered care across primary and secondary levels, and providing robust socioeconomic support are essential strategies for reducing unfavorable outcomes and achieving more equitable tuberculosis control.