Uptake and Implications of Rapid Molecular Testing for Tuberculosis in Brazil, 2019-2024 Open Access
Seidman, Joseph (Spring 2026)
Abstract
Background: Rapid molecular testing (RMT) is a routine diagnostic method for tuberculosis disease that also provides drug resistance profiles. Since its recommendation in Brazil in 2019, the proportion of TB diagnoses made by RMT has increased substantially. However, effective elimination of TB in Brazil requires equitable access to RMT, which has not been explored.
Objective: This analysis aims to investigate patient-level and municipal-level factors associated with receipt of RMT upon diagnosis and to determine the association of RMT receipt with TB treatment outcome.
Methods: Data from the Brazilian TB surveillance system (SINAN) between 2019-2024 were supplemented with primary care budgets and coverage from the municipality in which each case was diagnosed. Individual sociodemographic and clinical factors plus municipal-level indicators of healthcare infrastructure were examined using log binomial regression to estimate unadjusted associations between each factor and receipt of RMT for TB. Subsequently, each factor was examined for interaction by year and/or COVID-19 pandemic to determine if associations varied over time. Finally, receipt of RMT was modeled using robust poisson regression to determine the association between RMT and treatment outcome, examining interaction by region.
Results: Factors associated with receipt of RMT for TB were East-Asian race (RR = 1.42, 95% CI (1.34-1.51)), diagnosis in the Southeast region of Brazil (RR = 1.32 (1.31-1.34)), and immigrant status (RR = 1.27 (1.22-1.32)). Diagnosis in a municipality with high healthcare coverage yielded a strong negative association with receipt of RMT (RR = 0.64 (0.63-0.65)), while diagnosis in a municipality with high primary care funding was positively associated (RR = 1.17 (1.15-1.18)). All interactions with time were significant. Receipt of RMT was overall associated with favorable treatment outcome (RR = 1.01, 95% CI (1.00, 1.02)). Receipt of RMT was associated with favorable treatment outcomes in the Southeastern (RR = 1.03 (1.02-1.04)), Southern (RR = 1.02, (1.01-1.03)), Northeastern (RR = 1.01 (1.00-1.02)), and Northern (RR = 0.99 (0.98, 1.00)) regions of Brazil.
Conclusions: We found that receipt of RMT for TB diagnosis in Brazil varied by region and race. Our findings suggest that targeted efforts to increase uptake of RMT may improve TB outcomes in Brazil.
Table of Contents
INTRODUCTION ……………………………………………………………………………………… 1
METHODS ……………………………………………………………………………………………… 3
Data Sources ……………………………………………………………………………………………. 3
Study Population ………………………………………………………………………………………. 4
Study Variables ………………………………………………………………………………………… 4
Data Analysis ………………………………………………………………………………………….. 5
RESULTS ……………………………………………………………………………………………….. 6
Descriptive Analyses …………………………………………………………………………………. 6
Associations with Receipt of RMT ………………………………………………………………… 8
Rapid Molecular Test and TB Treatment Outcome …………………………………………... 20
DISCUSSION …………………………………………………………………………………………... 21
CONCLUSION ………………………………………………………………………………………… 23
SUPPLEMENT ………………………………………………………………………………………… 25
REFERENCES …………………………………………………………………………………………. 32
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