Completeness of preventive therapy for tuberculosis in indigenous versus nonindigenous populations in the Brazilian Amazon: a retrospective cohort study

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Pinheiro, Lara B. O. Assis, Djane Clarys Baia-da-Silva, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6811654/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Dec, 2025 Read the published version in BMC Public Health → Version 1 posted 20 You are reading this latest preprint version Abstract Background Tuberculosis preventive therapy (TPT) is crucial for preventing the progression from TB infection (TBI) to active disease, particularly among vulnerable populations such as indigenous people. Although shorter regimens have improved adherence, evidence from real-world programmatic settings is limited. This study evaluated whether the indigenous race was associated with greater TPT completion in the Brazilian Amazon. Methods We conducted a retrospective cohort study using data from the IL-TB database (2019–2023) in Amazonas, Brazil. Individuals who initiated TPT were stratified by race. The primary outcome was TPT completion. Multivariate logistic regression identified factors associated with completion, adjusting for sociodemographic, clinical, and operational variables. Results Of the 4,887 individuals, 79.6% completed TPT. Completion was higher among Indigenous individuals (90.9%) than among Nonindigenous individuals (79.1%) (p < 0.001). In the adjusted analysis, indigenous race (OR: 2.4; 95% CI: 1.49–4.06), shortened TPT regimens (OR: 2.36; 95% CI: 2.04–2.73), and receiving care in noncapital municipalities (OR: 2.03; 95% CI: 1.49–2.82) were positively associated with completion. Foreign nationality (OR: 0.28; 95% CI: 0.18–0.44) and TPT nonexclusive primary health care services (OR: 0.79; 95% CI: 0.66–0.94) were negatively associated with such outcomes. Among nonindigenous individuals, associations mirrored those in the overall population. Among Indigenous individuals, only a shortened regimen was significantly associated with completion (OR: 5.75; 95% CI: 1.78–23.4). Conclusions Indigenous individuals presented greater TPT completion, particularly when treated with shortened regimens. These findings reinforce the potential of decentralized strategies and the use of shortened regimens to increase the completeness of tuberculosis preventive therapy and provide evidence for overcoming historical and operational barriers at the program level that still prevail and delay the improvement of public policies aimed at achieving global TB elimination goals, especially in high-burden settings, social inequality and the strong presence of vulnerable populations. Healthcare disparities Primary health care Program evaluation Figures Figure 1 Figure 2 BACKGROUND Approximately 25% of the world's population is thought to be infected with Mycobacterium tuberculosis , and between 5% and 10% of these individuals will progress to active tuberculosis (TB) ( 1 ). In low- and middle-income countries, the risk of TB progression and the overall disease burden are elevated due to poverty-related conditions. This risk is even greater among vulnerable populations such as indigenous people, migrants, persons with HIV (PLHIV), household TB contacts (especially children under 5 years), and individuals receiving immunosuppressive therapy ( 1 – 3 ). Tuberculosis preventive therapy (TPT) is a key strategy for eliminating tuberculosis ( 4 ), particularly among vulnerable groups such as indigenous peoples, PLHIV, and individuals with household exposure to TB ( 5 ). Once active disease has been ruled out, the World Health Organization (WHO) recommends TPT for those at increased risk of developing tuberculosis infection (TBI) ( 1 ). Isoniazid preventive therapy (IPT) for a 6- or 9-month regimen of daily isoniazid (6H/9H) has historically been widely used; however, its effectiveness is often limited by low completion rates and challenges associated with its extended duration ( 6 ). A shorter regimen recommended by the WHO—three months of once-weekly rifapentine plus isoniazid (3HP)—is noninferior to nine months of IPT and has been associated with higher adherence and completion rates ( 7 ). In 2021, Brazil incorporated 3HP into its national TB program as an option for high-risk groups ( 3 ). Although studies have demonstrated the safety, tolerability, and effectiveness of 3HP in clinical trial settings ( 7 – 10 ), evidence of its programmatic impact, particularly among indigenous communities, remains limited. Thus, we evaluated whether the self-declared Indigenous race was associated with a higher probability of completing TPT in Amazonas, Brazil, where shortened regimens such as 3HP and four months of daily rifampicin (4R) have been widely implemented. We also explored the operational characteristics of surveillance and healthcare delivery to understand the impact of tailored interventions in this high TB burden setting. In 2024, Amazonas recorded a TB incidence of 94.7 per 100,000 inhabitants—the highest among Brazilian states—with Manaus leading among state capitals ( 11 ). The state has unique anthropological, social, cultural, epidemiological, and health service organization characteristics ( 12 ). Factors such as poor living conditions, limited healthcare access, malnutrition, and infrastructure deficits – commonly present in the Amazon – are associated globally with higher TB incidence ( 13 ). METHODS Study Design This retrospective cohort study evaluated whether self-declared Indigenous races were associated with greater TPT completion than nonindigenous races were in Amazonas state, Brazil, between 2019 and 2023. We included new TPT cases among Amazonas residents. The exclusion criteria were cases of primary chemoprophylaxis (e.g., newborns cohabiting with a laboratory-confirmed pulmonary or laryngeal TB case) and records lacking information on race or TPT outcome. Data collection and variable definitions Data were extracted in June 2024 from the National Information System for Latent Infection by Mycobacterium tuberculosis (IL-TB), with authorization from the Amazonas Health Surveillance Foundation “Dra. Rosemary Costa Pinto.” In Brazil, racial classification is based on self-identification, reflecting social, cultural, and historical contexts ( 14 , 15 ). According to the 2022 census ( 16 ), 12.5% of the Amazonas population self-identified as indigenous, comprising diverse ethnic groups, including Yanomami, Kayapó, Ticuna, Guarani, Munduruku, and Ashaninka. Some records also include Indigenous groups from neighboring countries, such as the Warao from Venezuela ( 15 ). The group of Indigenous individuals was defined on the basis of the completion of this category in the race/color field of the IL-TB system. In contrast, the group of nonindigenous individuals was composed of individuals categorized as White, Brown, Black, or Yellow. The IL-TB system collects sociodemographic, epidemiological, clinical, and operational variables. It was developed and implemented nationally in 2019 by the Brazilian Ministry of Health to support the surveillance of latent M. tuberculosis infection. The system defines four eligibility categories for TPT based on Tuberculin skin test (TST) or Interferon Gamma Release Assay (IGRA) results: (a) no TST or IGRA performed; (b) TST ≥ 5 mm or IGRA positive; (c) TST ≥ 10 mm or IGRA positive; and (d) TST conversion (≥ 10 mm increase compared to baseline), each with its respective indication for Therapy Preventive Tuberculosis ( 17 ). For analysis, indications for TPT were grouped into three categories: contact with a TB case, person with HIV, and others. The TPT outcome was defined as either complete or incomplete. Completion was assigned to the “complete treatment” category. At the same time, incomplete outcomes included “Suspended due to adverse reactions,” “Active tuberculosis,” “Death,” “Treatment interruption,” “Transferred to another country,” and “Suspended due to clinical conditions.” The IL-TB system also records sociodemographic and epidemiological data (age, sex, race, residence, TB contact history); clinical data (BCG vaccination, chest X-ray, HIV status, antiretroviral therapy [ART], TST, IGRA); and operational characteristics (type of entry, facility location and type, treatment regimen, prescribing professional, number of doses taken, and treatment closure status). On the basis of these variables, additional operational variables were derived: Location of health unit (capital vs. interior, based on municipal codes); Health service type (exclusively primary health care vs. health services with multiple types of care, including TB control program teams); Latent TB infection (TBI) investigation test performed (TST or IGRA); TBI confirmed by test (TST ≥ 5 mm or IGRA positive) and; Shortened TPT regimen (3HP or 4R vs. 6H/9H). All variables and definitions are presented in Supplementary Table 1. Statistical analysis Continuous variables were summarized using medians and interquartile ranges (IQRs). Categorical variables are presented as absolute and relative frequencies. As appropriate, group comparisons by race and TPT completion status were performed via the Mann–Whitney U test or Student’s t test according to the variable distribution. A significance level of p < 0.05 was adopted. Simple and multivariable binomial logistic regression models were used to estimate odds ratios (ORs) with corresponding 95% CIs and p values. Regression models were applied to the entire study population and separately to the Indigenous and Nonindigenous subgroups. Confounding variables such as age, sex, and TPT indications for PLHIV were retained in the multivariable models. Continuous variables with missing data and those indirectly represented by categorical variables (e.g., number of doses vs. treatment regimen) were excluded. The final multivariable model was selected on the basis of the lowest Akaike information criterion (AIC) and evaluation of multicollinearity via the variance inflation factor (VIF). Model adequacy and goodness-of-fit were assessed through multiple diagnostics, including inspection of the sigmoid curve ( Supplementary Fig. 3–5A ), the deviance goodness-of-fit test (based on a chi-square distribution), Pearson’s standardized residuals, the Hosmer–Lemeshow test, and the simulated standard envelope plot ( Supplementary Fig. 3–5B ). These visual assessments are provided in detail in the supplementary material to support the interpretation of model performance. All analyses were conducted via R software (R Development Core Team, 2024). RESULTS Of the 5,341 records identified between 2019 and 2023, 4,887 new cases were included in the study. Among them, 3,892 completed TPT (3,691 nonindigenous vs. 201 indigenous), whereas 995 did not (975 nonindigenous vs. 20 indigenous) ( Fig. 1 ) . Study population characteristics Table 1 summarizes the characteristics of the study population stratified by self-reported race. A greater proportion of males was observed among Indigenous individuals than among Nonindigenous individuals (56.6% vs. 49.5%; p = 0.048). Brazilian nationality was less common among indigenous individuals (89.6% vs. 98.3%; p < 0.001). Additionally, indigenous individuals more often received TPT in health services located in the interior of the state (52.9% vs. 9.4%; p < 0.001). Table 1 Characteristics of the study population stratified according to Race [ALL] b Nonindigenous Indigenous c p.overall Characteristics 4887 (N;%) 4666 (N;%) 221 (N;%) Sex: 0.048 Female 2451 (50.2) 2355 (50.5) 96 (43.4) Male 2436 (49.8) 2311 (49.5) 125 (56.6) Age group (y): 0.737 = 18 3902 (79.8) 3728 (79.9) 174 (78.7) Nationality: <0.001 Brazilian 4785 (97.9) 4587 (98.3) 198 (89.6) Foreign 102 (2.1) 79 (1.79) 23 (10.4) History of contact with TB cases: <0.001 Not 1999 (40.9) 1973 (42.3) 26 (11.8) Yes 2888 (59.1) 2693 (57.7) 195 (88.2) Location of the Health Unit: <0.001 Capital 4333 (88.7) 4229 (90.6) 104 (47.1) Interior 554 (11.3) 437 (9.4) 117 (52.9) Health services with multiple types of care a : <0.001 Not 2090 (42.8) 1956 (41.9) 134 (60.6) Yes 2797 (57.2) 2710 (58.1) 87 (39.4) Performed test by investigate TBI (TST/IGRA): <0.001 Not 538 (11.0) 533 (11.4) 5 (2.3) Yes 4349 (89.0) 4133 (88.6) 216 (97.7) TBI confirmed by test (TST/IGRA): <0.001 Not 712 (14.6) 704 (15.1) 8 (3.6) Yes 4175 (85.4) 3962 (84.9) 213 (96.4) Indication of TPT for PLHIV: <0.001 Not 3579 (73.2) 3371 (72.2) 208 (94.1) Yes 1308 (26.8) 1295 (27.8) 13 (5.9) Shortened TPT (3HP/4R): 0.938 Not 1989 (40.7) 1898 (40.7) 91 (41.2) Yes 2898 (59.3) 2768 (59.3) 130 (58.8) Closure status of TPT: <0.001 Incomplete 995 (20.4) 975 (20.9) 20 (9.1) Complete 3892 (79.6) 3691 (79.1) 201 (91.0) Table note a Services with different types of health care, not exclusively primary care. b Nonindigenous race includes white, black, brown or yellow. c P-value of the study population. IL-TB, Information System for Latent Infection by M. tuberculosis , AM-BR, 2019–2023. Abbreviations: PLHIV, person with human immunodeficiency virus; TB, tuberculosis; TBI, tuberculosis infection; ± SD, standard deviation; TST, Tuberculin skin test; IGRA, interferon gamma release assay. Nonindigenous individuals were more likely to receive TPT in services with multiple types of care (58.1%), whereas indigenous individuals more frequently received care exclusively through primary health care services (60.6%). Diagnostic tests (TSTs/IGRAs) for TBI were performed more regularly among indigenous individuals than among nonindigenous individuals (97.7% vs. 88.6%; p < 0.001). Indigenous individuals also presented higher rates of TBI confirmation and TB contact history (96.4% vs. 84.9%; p < 0.001 and 88.2% vs. 57.7%; p < 0.001, respectively). The proportion of TPT indications for PLHIV was lower among indigenous individuals (5.9% vs. 27.8%; p < 0.001). TPT completion was more common among Indigenous individuals than among Nonindigenous individuals (91.0% vs. 79.1%; p < 0.001). Table 2 summarizes the characteristics of the study population according to TPT completion and race. The overall completion rate was 79.6%, with indigenous individuals demonstrating a higher completion rate (90.9%) than nonindigenous individuals did (79.1%). Unlike what was observed in the total population and among nonindigenous people, men had a higher proportion of complete TPT among indigenous people (56.7%). Individuals under 18 years of age had slightly higher completion rates (20.8% complete vs. 17.6% incomplete; p = 0.027). Among adults, the highest proportion of TPT completion was observed among nonindigenous individuals (79.2% vs. 78.1% among indigenous individuals). Table 2 Characteristics of the study population stratified according to TPT completion and by race [ALL] b Nonindigenous Indigenous c p.overall Incomplete (N;%) Complete (N;%) Incomplete (N;%) Complete (N;%) Incomplete (N;%) Complete (N;%) Characteristics 995 (20.4) 3892 (79.6) 975 (20.9) 3691 (79.1) 20 (9.1) 201 (90.9) Sex: 0.914 Female 497 (49.9) 1954 (50.2) 488 (50.1) 1867 (50.6) 9 (45.0) 87 (43.3) Male 498 (50.1) 1938 (49.8) 487 (49.9) 1824 (49.4) 11 (55.0) 114 (56.7) Age group (y): 0.027 = 18 820 (82.4) 3082 (79.2) 803 (82.4) 2925 (79.2) 17 (85.0) 157 (78.1) Race: < 0.001 Nonindigenous 975 (98.0) 3691 (94.8) - - - - Indigenous 20 (2.0) 201 (5.2) - - - - Nationality: < 0.001 Brazilian 959 (96.4) 3826 (98.3) 942 (96.6) 3645 (98.8) 17 (85.0) 181 (90.0) Foreign 36 (3.62) 66 (1.70) 33 (3.38) 46 (1.25) 3 (15.0) 20 (10.0) History of contact with TB cases 0.003 Not 448 (45.0) 1551 (39.9) 443 (45.4) 1530 (41.5) 5 (25.0) 21 (10.4) Yes 547 (55.0) 2341 (60.1) 532 (54.6) 2161 (58.5) 15 (75.0) 180 (89.6) Location of the Health Unit: < 0.001 Capital 944 (94.9) 3389 (87.1) 934 (95.8) 3295 (89.3) 10 (50.0) 94 (46.8) Interior 51 (5.1) 503 (12.9) 41 (4.21) 396 (10.7) 10 (50.0) 107 (53.2) Health services with multiple types of care a : < 0.001 Not 370 (37.2) 1720 (44.2) 361 (37.0) 1595 (43.2) 9 (45.0) 125 (62.2) Yes 625 (62.8) 2172 (55.8) 614 (63.0) 2096 (56.8) 11 (55.0) 76 (37.8) Performed test by investigate TBI (TST/IGRA): 0.054 Not 127 (12.8) 411 (10.6) 126 (12.9) 407 (11.0) 1 (5.00) 4 (2.0) Yes 868 (87.2) 3481 (89.4) 849 (87.1) 3284 (89.0) 19 (95.0) 197 (98.0) TBI confirmed by test (TST/IGRA): 0.006 Not 173 (17.4) 539 (13.8) 172 (17.6) 532 (14.4) 1 (5.00) 7 (3.5) Yes 822 (82.6) 3353 (86.2) 803 (82.4) 3159 (85.6) 19 (95.0) 194 (96.5) Indication of TPT for PLHIV: 0.144 Not 710 (71.4) 2869 (73.7) 690 (70.8) 2681 (72.6) 20 (100.0) 188 (93.5) Yes 285 (28.6) 1023 (26.3) 285 (29.2) 1010 (27.4) 0 (0.0) 13 (6.47) Shortened TPT (3HP/4R): < 0.001 Not 559 (56.2) 1430 (36.7) 545 (55.9) 1353 (36.7) 14 (70.0) 77 (38.3) Yes 436 (43.8) 2462 (63.3) 430 (44.1) 2338 (63.3) 6 (30.0) 124 (61.7) Table note: a Services with different types of health care, not exclusively primary care. b Nonindigenous race includes white, black, brown or yellow. c P-value of the study population. IL-TB, Information System for Latent Infection by M. tuberculosis, AM-BR, 2019–2023. Abbreviations: PLHIV, person with human immunodeficiency virus; TB, tuberculosis; TBI, tuberculosis infection; + SD, standard deviation; TST, tuberculin skin test; IGRA, interferon gamma release assay. Brazilian nationality predominated across all groups, although the proportion of foreign nationals was greater among individuals who did not complete TPT (3.6% vs. 1.70%; p < 0.001). TB contact was more common among individuals who completed TPT (60.1% vs. 55%; p = 0.003) and among indigenous individuals than among nonindigenous individuals (89.6% vs. 58.5%). With respect to health unit location, individuals who completed TPT were more frequently treated in interior municipalities (12.9% vs. 5.1%; p < 0.001), a pattern also observed among indigenous participants. Among the indigenous individuals who completed TPT, 62.2% received care exclusively for primary health care services, whereas 43.2% of the nonindigenous individuals did. The performance of tests for TBI investigation (TST/IGRA) was high across all groups, with slightly higher proportions among individuals who completed TPT in the general population (89.4%) and among indigenous participants (98.0%). Confirmation of the TBI by test was observed in 86.2% of individuals who completed TPT (p = 0.006) and in 96.5% of Indigenous individuals. TPT indications for PLHIV were reported in 26.3% of the completers in the general population and in 6.5% of the Indigenous individuals. The use of shortened TPT regimens (3HP/4R) was more common among all groups who completed TPT, with a significant difference in the general population (63.3% vs. 43.8%; p < 0.001). Factors associated with TPT completion in the study population According to the adjusted logistic regression model, TPT completion was positively associated with the Indigenous race (OR: 2.4; 95% CI: 1.49–4.06; p < 0.001), treatment in health units located in the interior (OR: 2.03; 95% CI: 1.49–2.82; p < 0.001), and the use of shortened TPT regimens (OR: 2.36; 95% CI: 2.04–2.73; p < 0.001). Conversely, foreign nationality (OR: 0.28; 95% CI: 0.18–0.44; p < 0.001) and receiving care in services with multiple types of care (OR: 0.79; 95% CI: 0.66–0.94; p = 0.008) were associated with lower odds of completing TPT. Additionally, TBI confirmed by TST/IGRA (OR: 1.57; 95% CI: 1.06–2.31; p = 0.022) and TPT indications for PLHIV (OR: 1.31; 95% CI: 1.04–1.65; p = 0.020) were also positively associated with TPT completion ( Fig. 2 ) . When factors associated with TPT completion by subpopulation were analyzed, the adjusted model for indigenous individuals revealed that only the use of the shortened 3HP/4R regimen was significantly associated with completion (OR: 5.75; 95% CI: 1.78–23.4; p = 0.006), as shown in Supplementary Fig. 2 . Among nonindigenous individuals, shortened regimens (OR: 2.31; 95% CI: 1.99–2.68; p < 0.001), TPT performed in interior municipalities (OR: 2.25; 95% CI: 1.61–3.23; p < 0.001), TBI confirmation (OR: 1.58; 95% CI: 1.06–2.32; p = 0.020), and TPT indication for PLHIV (OR: 1.28; 95% CI: 1.02–1.61; p = 0.036) were all positively associated with treatment completion. Conversely, as observed in the total population, among nonindigenous individuals, being a foreign nation (OR: 0.25; 95% CI: 0.16–0.41; p < 0.001) and receiving TPT in services with multiple types of care (OR: 0.8; 95% CI: 0.67–0.96; p = 0.018) were associated with lower odds of completion (Supplementary Fig. 1) . DISCUSSION In Brazil, TPT was not historically prioritized as a central component of TB control. Although incorporated into national guidelines between 2011 and 2018, active case finding remained the primary preventive measure. TPT was mainly recommended for specific groups, such as contacts of laboratory-confirmed pulmonary TB cases, PLHIV, and individuals in areas with better TB indicators and lower treatment interruption rate ( 18 ). Until the first half of 2021, the primary regimen available for TPT in Brazil was Isoniazid monotherapy (6H or 9H). Although 4R (four months of daily rifampicin) was also available, its use remained limited to specific populations ( 19 ). Following the incorporation of 3HP into the public health system in the second half of 2021, this regimen progressively replaced Isoniazid monotherapy and, by the end of 2023, accounted for approximately 50% of TPT initiations nationally. In Amazonas, however, uptake was faster, with 3HP representing around 90% of all TPT initiations ( 11 ). The rapid implementation of 3HP contributed to its consolidation as the preferred regimen in the Amazonas, a region marked by both high TB burden and the largest Indigenous population in the country, most of whom reside in municipalities located in the interior ( 16 ). This study provides important insights into TPT outcomes in the Brazilian Amazon, revealing high overall completion rates and significantly better adherence among indigenous individuals. These findings challenge the prevailing assumption that indigenous populations consistently experience poorer outcomes due to social vulnerability ( 20 ). Instead, our data suggest that targeted strategies—such as shorter regimens and decentralized care delivery—may have played a pivotal role in improving adherence in these communities. The strong association between shortened TPT regimens and completion, particularly among indigenous individuals, reinforces the importance of treatment simplification in enhancing adherence. In our stratified analysis, the use of a short regimen was the only factor significantly associated with completion in the Indigenous subgroup. This aligns with previous literature demonstrating that strong social cohesion and community engagement—often observed in indigenous populations—facilitate adherence, especially when culturally adapted interventions and trusted local leaders are involved ( 21 , 22 ). Extensive global evidence also highlights the disproportionate burden of TB among indigenous peoples and the need for tailored approaches to improve access and outcomes ( 23 – 28 ). Our findings contribute real-world programmatic evidence supporting this approach in a high-burden region. The positive association between TPT completion and care provided in interior municipalities highlights the potential impact of health system decentralization. Recent efforts to expand service delivery beyond capital cities may improve access and program effectiveness, particularly with community-based strategies ( 29 ). Additionally, TPT completion was greater in services operating exclusively through primary health care (PHC), supporting models emphasizing accessibility, continuity of care, and trust between providers and patients ( 30 ). Conversely, foreign nationality was associated with lower odds of TPT completion, underscoring well-documented barriers faced by migrants and nonnationals, such as limited knowledge about latent TB, stigma, and restricted access to care. Evidence from other high-burden countries suggests that foreign-born individuals may benefit from intensified support strategies, including culturally adapted counseling and directly observed therapy ( 31 ). These results emphasize the need for inclusive policies and health services tailored to all vulnerable groups’ linguistic and cultural needs. This study has several limitations. Using secondary data from a programmatic database may involve information bias, including incomplete or inaccurate outcome reporting. Health workers self-identify or classify races, which may not fully capture their sociocultural identity. However, the maintenance of key covariates and the selection of our model on the basis of careful assumptions of fit and adequacy sought to minimize confounding and emphasize the representativeness of the population of our study in the Brazilian Amazon scenario. Despite these limitations, our findings offer robust real-world evidence that simplified TPT regimens, combined with decentralized and primary healthcare–based delivery models, can substantially improve treatment completion in high-burden and underserved settings. Indigenous individuals’ notably high completion rates demonstrate that equity-focused and culturally sensitive interventions can overcome historical barriers and deliver successful TB prevention outcomes. Scaling up access to short-course regimens and strengthening local health systems are critical next steps to advance TB elimination in the Amazon and similar contexts. CONCLUSIONS Our findings offer robust real-world evidence that simplified TPT regimens, combined with decentralized and primary healthcare–based delivery models, can substantially improve treatment completion in high-burden and underserved settings. Indigenous individuals’ notably high completion rates demonstrate that equity-focused and culturally sensitive interventions can overcome historical barriers and deliver successful TB prevention outcomes. Scaling up access to short-course regimens and strengthening local health systems are critical next steps to advance TB elimination in the Amazon and similar contexts. Abbreviations TPT Tuberculosis Preventive Therapy TB Tuberculosis TBI Tuberculosis Infection PLHIV People Living with Human Immunodeficiency Virus TST Tuberculin Skin Test IGRA Interferon Gamma Release Assay 3HP 3-month regimen of weekly isoniazid and rifapentine 4R 4-month regimen of daily rifampicin IPT 6H/9H Isoniazid Preventive Therapy for 6/9-month regimen of daily isoniazid IL-TB Information System for Latent Infection by M. tuberculosis AIC Akaike Information Criterion VIF Variance Inflation Factor CI Confidence Interval OR Odds Ratio SD Standard Deviation Declarations Ethics approval and consent to participate This study used anonymized secondary data from the Mycobacterium tuberculosis Infection Information System, with authorization from the Amazonas Health Surveillance Foundation, as described in the item "Data collection and variable definitions" in the "Methods" section. According to Resolution No. 510, of April 7, 2016, of the National Health Council of Brazil, which governs the ethical standards for research in the Human and Social Sciences in Brazil, obtaining the Informed Consent Form may be waived in cases of use of anonymized secondary data, if it is duly justified and approved by the Research Ethics Committee. The study protocol was approved by the Ethics Committee of the Dr. Heitor Vieira Dourado Tropical Medicine Foundation (CAAE: 74993423.8.0000.0005), with the due dispensation of Informed Consent Form. In addition, the research was conducted in accordance with the ethical principles set forth in the World Medical Association's Declaration of Helsinki, which guides medical research involving human subjects, ensuring compliance with relevant national and international ethical standards. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study will be available upon reasonable request to the corresponding author of the study. Competing interests The authors declare that they have no competing interests. Funding The study was supported by the intramural Programa de Pós-Graduação em Medicina Tropical of the Universidade do Estado do Amazonas and Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (to JSP, DCBS, LSG, RSG, MCS); the intramural Programa Estadual de Controle da Tuberculose do Amazona of the Fundação de Vigilância em Saúde do Amazonas Dra. Rosemary Costa Pinto (to LBOA, IPS); and the intramural Instituto de Pesquisa em Populações Prioritárias (IRPP), Instituto MONSTER de Ensino, Assistência, Pesquisa e Desenvolvimento Tecnológico em Saúde (to BBD, KVS, MMR, BBA). JSP and LSG received a fellowship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [Case number: 88887.802821/2023-00 and 88887.148541/2025-00, respectively]. BBA and MCS are fellows from the Conselho Nacional de Desenvolvimento Científico e Tecnológico. Authors' contributions Conceptualization: JSP, BBD, BBA, MCS. Data verification and curation: JSP, LBOA, BBD, RSG, LSG, BBA, MCS. Investigation: JSP, LBOA, BBD, KVS, MMR, BBA, MCS. Formal analysis: JSP, LBOA, IPS, BBD, MMR, RSG, DCBS, LSG, KVS, BBA, MCS. Funding acquisition: JSP, BBA, MCS. Methodology: JSP, BBD, KVS, MMR, BBA, MCS. All authors read and approved the final version of the manuscript. Acknowledgments We thank the institutions that contributed to the study: the Universidade do Estado do Amazonas (UEA), which is in broad agreement with the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD); the Fundação de Vigilância em Saúde do Amazonas Dra. Rosemary Costa Pinto (FVS-RCP); the Secretaria Municipal de Saúde de Manaus-AM (Semsa); the Instituto de Pesquisa em Populações Prioritárias (IRPP), Instituto MONSTER de Ensino, Assistência, Pesquisa e Desenvolvimento Tecnológico em Saúde; the Superintendência da Zona Franca de Manaus (Suframa); the Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM); the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). References World Health Organization. WHO global tuberculosis report 2024 [Internet]. Geneva: WHO; 2024. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2024 Chatterjee GJ, Sharma S. Controlling latent tuberculosis infection in high-burden countries: a neglected strategy to end TB. J Epidemiol Glob Health . 2019 Mar;9(1):42–4. doi:10.1016/j.jegh.2018.06.001 Brasil. Nota Informativa n° 5/2021-CGDR/DCCI/SVS/MS: Departamento de HIV, Aids, Tuberculose, Hepatites Virais e IST [Internet]. Brasília: Ministério da Saúde; 2021. Available from: https://www.gov.br/aids/pt-br/central-de-conteudo/notas-informativas/2021/nota-informativa-no-5-2021-cgdr-dcci-svs-ms/view 4. Dye C, Glaziou P, Floyd K, Raviglione M. Prospects for tuberculosis elimination. Annu Rev Public Health . 2013;34:271–86. doi:10.1146/annurev-publhealth-031912-114431 Kumari R. Tribal health in India: overcoming public health challenges with a focus on tuberculosis. Apollo Med. 2025;22(1):76–83. Cola JP, Nascimento do Prado T, Alves KBA, Lapa e Silva JR, Trajman A, Golub JE, et al. Factors associated with noncompletion of TB preventive treatment in Brazil. Int J Tuberc Lung Dis . 2023;27(3):215–20. Kinikar A, Borse R, Randive B, Kamath P, Mattoo SK, Parmar M, et al. 3HP preventive treatment among children and adolescents with HIV and child household contacts of TB patients. IJTLD Open . 2024;1(9):413–7. Pease C, Amaratunga K, Alvarez G. A shorter treatment regimen for latent tuberculosis infection holds promise for at-risk Canadians. Can Commun Dis Rep. 2017;43(3/4):67–71. Borse R, Randive B, Mattoo S, Malik P, Solanki H, Gupta A, et al. Three months of weekly rifapentine plus isoniazid for TB prevention among people with HIV. IJTLD Open. 2024 ;1(9):404–9. Sterling TR, Scott NA, Miró JM, Calvet G, La Rosa A, Infante R, et al. Three months of weekly rifapentine plus isoniazid for treatment of M. tuberculosis infection in HIV coinfected persons. AIDS . 2016;30(10):1607–15. Brasil. Boletim Epidemiológico – Tuberculose 2024 . Brasília: Ministério da Saúde; 2024. Available from: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2024/boletim-epidemiologico-tuberculose-2024/view Souza JE, Costa CA, França GP, Alonso N, et al. Difficulties in accessing medical surgical care in the Amazonas. In: Mikkola H, editor. Amazon Ecosystem - Past Discoveries and Future Prospects . London: IntechOpen; 2023. doi:10.5772/intechopen.1003082 Teibo TKA, Andrade RL, Rosa RJ, Abreu PD, Olayemi OA, Alves YM, et al. Barriers that interfere with access to tuberculosis diagnosis and treatment across countries globally: a systematic review. ACS Infect Dis. 2024;10(8):2600–14. doi:10.1021/acsinfecdis.4c00466 Petruccelli JL, Saboia AL, orgs. Características étnico-raciais da população: classificações e identidades. Rio de Janeiro: IBGE; 2013. 204 p. (Estudos e Análises: Informação Demográfica e Socioeconômica; n. 2). Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv63405.pdf I Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico 2022: indígenas: primeiros resultados do universo . Rio de Janeiro: IBGE; 2023. 193 p. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv102018.pdf Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico 2022: características étnico-raciais da população. Rio de Janeiro: IBGE; 2023. Available from: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/38719-censo-2022-pela-primeira-vez-desde-1991-a-maior-parte-da-populacao-do-brasil-se-declara-parda Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo de vigilância da infecção latente pelo Mycobacterium tuberculosis no Brasil . 2ª ed. Brasília: Ministério da Saúde; 2022. 36 p. ISBN 978-65-5993-204-7. Available from: https://www.gov.br/aids/pt-br/central-de-conteudo/publicacoes/2022/af_protocolo_vigilancia_iltb_2ed_9jun22_ok_web.pdf/view Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Manual de recomendações para o controle da tuberculose no Brasil . Brasília: Ministério da Saúde; 2011. 284 p. (Série A. Normas e Manuais Técnicos). ISBN: 978-85-334-1816-5. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil.pdf Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Protocolo de vigilância da infecção latente pelo Mycobacterium tuberculosis no Brasil . Brasília: Ministério da Saúde; 2018. 32 p. ISBN: 978-85-334-2650-4. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/protocolo_vigilancia_infeccao_latente_mycobacterium_tuberculosis_brasil.pdf Basta PC, Viana PV. Determinants of tuberculosis in Indigenous people worldwide. Lancet Glob Health . 2018;6(6):e678–85. Andrade SR, Vidor AC, Ribeiro JC, Ribeiro CEP. Indicadores e rede de atenção: uma experiência do Programa de Educação pelo Trabalho em Vigilância em Saúde. Interface (Botucatu) . 2015;19(Supl 1):913–22. doi:10.1590/1807-57622014.0826. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep . 2003;118(4):293–302. doi:10.1093/phr/118.4.293. Basta PC, Rios DPG, Alves LCC, Sant’Anna CC, Coimbra Jr CEA. Estudo clínico-radiológico de crianças e adolescentes indígenas Suruí, região amazônica. Rev Soc Bras Med Trop. 2010;43(6):719–22. Litvinjenko S, Magwood O, Wu S, Wei X. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. Lancet Infect Dis . 2023;23(10):e352–61. Eisenbeis L, Gao Z, Heffernan C, Yacoub W, Long R, Verma G. Contact investigation outcomes of Canadian-born adults with tuberculosis in Indigenous and non-Indigenous populations in Alberta. Can J Public Health . 2016;107(1):e106–11. Dehghani K, Lan Z, Li P, Michelsen SW, Waites S, Benedetti A, et al. Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study. Lancet Public Health . 2018;3(3):e133–42. Gopie FA, Hassankhan A, Ottevanger S, Krishnadath I, de Lange W, Zijlmans CWR, et al. Ethnic disparities in tuberculosis incidence and related factors among Indigenous and other communities in ethnically diverse Suriname. J Clin Tuberc Other Mycobact Dis . 2021;23:100227. Malacarne J, Kolte IV, Freitas LP, Orellana JDY, Souza MLP, Souza-Santos R, et al. Factors associated with TB in an Indigenous population in Brazil: the effect of a cash transfer program. Rev Inst Med Trop Sao Paulo . 2018;60:e63. Teixeira MG, Costa MCN, Paixão ES, Carmo EH, Barreto FR, Penna GO. Conquistas do SUS no enfrentamento das doenças transmissíveis. Ciênc Saúde Coletiva . 2020;25(4):1237–46. Mendes EV. As redes de atenção à saúde. Brasília: Organização Pan-Americana da Saúde (OPAS); 2011. Pease CP, Alvarez GG. A shorter treatment regimen for latent tuberculosis infection holds promise for at-risk Canadians. Can Commun Dis Rep. 2017;43(3/4):67–71. Available from: https://pubmed.ncbi.nlm.nih.gov/29770067/ Additional Declarations No competing interests reported. Supplementary Files TabSupp1AllCharacteristicsILTBStudyPopStratifiedRace.docx FigureSupplementslegends.docx FigSuppl1LogRegModelCompletionTPTNonindigenous.tiff FigSuppl2LogRegModelCompletionTPTIndigenous.tiff FigSuppl3AdequacyANormalityBStudyPopulation.tiff FigSuppl4AdequacyANormalityBNonindigenous.tiff FigSuppl5AdequacyANormalityBIndigenous.tiff Cite Share Download PDF Status: Published Journal Publication published 02 Dec, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 15 Jul, 2025 Reviews received at journal 11 Jul, 2025 Reviews received at journal 10 Jul, 2025 Reviews received at journal 09 Jul, 2025 Reviews received at journal 07 Jul, 2025 Reviews received at journal 03 Jul, 2025 Reviewers agreed at journal 28 Jun, 2025 Reviewers agreed at journal 26 Jun, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviews received at journal 25 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers agreed at journal 24 Jun, 2025 Reviewers agreed at journal 20 Jun, 2025 Reviewers invited by journal 19 Jun, 2025 Editor invited by journal 10 Jun, 2025 Editor assigned by journal 09 Jun, 2025 Submission checks completed at journal 09 Jun, 2025 First submitted to journal 03 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6811654","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":468967335,"identity":"e522ed30-23c0-4824-a4cc-47de47ae7e54","order_by":0,"name":"Jair S. 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(FMT-HVD)","correspondingAuthor":true,"prefix":"","firstName":"Marcelo","middleName":"","lastName":"Cordeiro-Santos","suffix":""}],"badges":[],"createdAt":"2025-06-03 13:08:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6811654/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6811654/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25177-8","type":"published","date":"2025-12-02T15:58:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84377041,"identity":"6b2d05cc-8c1f-4100-a247-61873310967b","added_by":"auto","created_at":"2025-06-11 08:32:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":627761,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of tuberculosis preventive therapy (TPT) cases reported in Amazonas, Brazil, from 2019--2023.\u003c/p\u003e\n\u003cp\u003eNotes:\u003c/p\u003e\n\u003cp\u003ea – Re-entry after scheme change (20), suspension due to a clinical condition unfavorable to treatment (02) and treatment interruption (62); re-exposure (05). b – Duplicates: same individual, type of input and different case digit (09); same individual, type of entry and digit as in case (12). c – Only 11 Indigenous.\u003c/p\u003e","description":"","filename":"Fig1FlowchartTPTcasesnotified.png","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/312034fd2b423cdf1e3bfd0e.png"},{"id":84377892,"identity":"9ec48fcd-de16-410f-a4b5-b8de9696401c","added_by":"auto","created_at":"2025-06-11 08:40:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":875175,"visible":true,"origin":"","legend":"\u003cp\u003eLogistic regression model depicting the associations between the completion of TPT and the characteristics of the study population.\u003c/p\u003e\n\u003cp\u003eAbbreviations: TB, tuberculosis; TBI, tuberculosis infection; TST, tuberculin skin test; IGRA, interferon gamma release assay; PLHIV, person with human immunodeficiency virus; TPT, tuberculosis preventive therapy.\u003c/p\u003e","description":"","filename":"Fig2LogRegModelCompletionTPTStudyPopulation.png","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/32705fdb91df90a0713a5c6f.png"},{"id":97902454,"identity":"664e6ac7-fb0c-40b5-9ff4-8587d72bdc9b","added_by":"auto","created_at":"2025-12-10 15:52:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3142344,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/60551a78-32c5-4ec7-8714-c38d2dc4b095.pdf"},{"id":84377034,"identity":"3be567de-f961-4e85-9fa1-436d351f38f6","added_by":"auto","created_at":"2025-06-11 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08:40:39","extension":"tiff","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":182868,"visible":true,"origin":"","legend":"","description":"","filename":"FigSuppl1LogRegModelCompletionTPTNonindigenous.tiff","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/2a0c3b8c4702bcdeace0abda.tiff"},{"id":84377045,"identity":"4a89be74-e883-453d-94f7-f77609665c9b","added_by":"auto","created_at":"2025-06-11 08:32:39","extension":"tiff","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":145485,"visible":true,"origin":"","legend":"","description":"","filename":"FigSuppl2LogRegModelCompletionTPTIndigenous.tiff","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/b9ddd9fcb23e5a72f29d0058.tiff"},{"id":84377051,"identity":"02c32ca2-c04c-4c05-afe4-bbaecd70b345","added_by":"auto","created_at":"2025-06-11 08:32:39","extension":"tiff","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":261939,"visible":true,"origin":"","legend":"","description":"","filename":"FigSuppl3AdequacyANormalityBStudyPopulation.tiff","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/6581ba244eb6c46ee7af6588.tiff"},{"id":84377896,"identity":"60881c5b-2030-4792-9dac-ee3981ff98fd","added_by":"auto","created_at":"2025-06-11 08:40:39","extension":"tiff","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":263247,"visible":true,"origin":"","legend":"","description":"","filename":"FigSuppl4AdequacyANormalityBNonindigenous.tiff","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/135b0411157c350a8938391c.tiff"},{"id":84377048,"identity":"1328d78b-5da4-41ca-b1ee-621526c53c54","added_by":"auto","created_at":"2025-06-11 08:32:39","extension":"tiff","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":280594,"visible":true,"origin":"","legend":"","description":"","filename":"FigSuppl5AdequacyANormalityBIndigenous.tiff","url":"https://assets-eu.researchsquare.com/files/rs-6811654/v1/f943e579f7af20540437f0bb.tiff"}],"financialInterests":"No competing interests reported.","formattedTitle":"Completeness of preventive therapy for tuberculosis in indigenous versus nonindigenous populations in the Brazilian Amazon: a retrospective cohort study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eApproximately 25% of the world's population is thought to be infected with \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e, and between 5% and 10% of these individuals will progress to active tuberculosis (TB) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In low- and middle-income countries, the risk of TB progression and the overall disease burden are elevated due to poverty-related conditions. This risk is even greater among vulnerable populations such as indigenous people, migrants, persons with HIV (PLHIV), household TB contacts (especially children under 5 years), and individuals receiving immunosuppressive therapy (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTuberculosis preventive therapy (TPT) is a key strategy for eliminating tuberculosis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), particularly among vulnerable groups such as indigenous peoples, PLHIV, and individuals with household exposure to TB (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Once active disease has been ruled out, the World Health Organization (WHO) recommends TPT for those at increased risk of developing tuberculosis infection (TBI) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIsoniazid preventive therapy (IPT) for a 6- or 9-month regimen of daily isoniazid (6H/9H) has historically been widely used; however, its effectiveness is often limited by low completion rates and challenges associated with its extended duration (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A shorter regimen recommended by the WHO\u0026mdash;three months of once-weekly rifapentine plus isoniazid (3HP)\u0026mdash;is noninferior to nine months of IPT and has been associated with higher adherence and completion rates (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In 2021, Brazil incorporated 3HP into its national TB program as an option for high-risk groups (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough studies have demonstrated the safety, tolerability, and effectiveness of 3HP in clinical trial settings (\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), evidence of its programmatic impact, particularly among indigenous communities, remains limited. Thus, we evaluated whether the self-declared Indigenous race was associated with a higher probability of completing TPT in Amazonas, Brazil, where shortened regimens such as 3HP and four months of daily rifampicin (4R) have been widely implemented. We also explored the operational characteristics of surveillance and healthcare delivery to understand the impact of tailored interventions in this high TB burden setting.\u003c/p\u003e \u003cp\u003eIn 2024, Amazonas recorded a TB incidence of 94.7 per 100,000 inhabitants\u0026mdash;the highest among Brazilian states\u0026mdash;with Manaus leading among state capitals (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The state has unique anthropological, social, cultural, epidemiological, and health service organization characteristics (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Factors such as poor living conditions, limited healthcare access, malnutrition, and infrastructure deficits \u0026ndash; commonly present in the Amazon \u0026ndash; are associated globally with higher TB incidence (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study evaluated whether self-declared Indigenous races were associated with greater TPT completion than nonindigenous races were in Amazonas state, Brazil, between 2019 and 2023.\u003c/p\u003e \u003cp\u003eWe included new TPT cases among Amazonas residents. The exclusion criteria were cases of primary chemoprophylaxis (e.g., newborns cohabiting with a laboratory-confirmed pulmonary or laryngeal TB case) and records lacking information on race or TPT outcome.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection and variable definitions\u003c/h3\u003e\n\u003cp\u003eData were extracted in June 2024 from the National Information System for Latent Infection by \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e (IL-TB), with authorization from the Amazonas Health Surveillance Foundation \u0026ldquo;Dra. Rosemary Costa Pinto.\u0026rdquo; In Brazil, racial classification is based on self-identification, reflecting social, cultural, and historical contexts (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). According to the 2022 census (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), 12.5% of the Amazonas population self-identified as indigenous, comprising diverse ethnic groups, including Yanomami, Kayap\u0026oacute;, Ticuna, Guarani, Munduruku, and Ashaninka. Some records also include Indigenous groups from neighboring countries, such as the Warao from Venezuela (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe group of Indigenous individuals was defined on the basis of the completion of this category in the race/color field of the IL-TB system. In contrast, the group of nonindigenous individuals was composed of individuals categorized as White, Brown, Black, or Yellow.\u003c/p\u003e \u003cp\u003eThe IL-TB system collects sociodemographic, epidemiological, clinical, and operational variables. It was developed and implemented nationally in 2019 by the Brazilian Ministry of Health to support the surveillance of latent \u003cem\u003eM. tuberculosis\u003c/em\u003e infection. The system defines four eligibility categories for TPT based on Tuberculin skin test (TST) or Interferon Gamma Release Assay (IGRA) results: (a) no TST or IGRA performed; (b) TST\u0026thinsp;\u0026ge;\u0026thinsp;5 mm or IGRA positive; (c) TST\u0026thinsp;\u0026ge;\u0026thinsp;10 mm or IGRA positive; and (d) TST conversion (\u0026ge;\u0026thinsp;10 mm increase compared to baseline), each with its respective indication for Therapy Preventive Tuberculosis (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor analysis, indications for TPT were grouped into three categories: contact with a TB case, person with HIV, and others.\u003c/p\u003e \u003cp\u003eThe TPT outcome was defined as either complete or incomplete. Completion was assigned to the \u0026ldquo;complete treatment\u0026rdquo; category. At the same time, incomplete outcomes included \u0026ldquo;Suspended due to adverse reactions,\u0026rdquo; \u0026ldquo;Active tuberculosis,\u0026rdquo; \u0026ldquo;Death,\u0026rdquo; \u0026ldquo;Treatment interruption,\u0026rdquo; \u0026ldquo;Transferred to another country,\u0026rdquo; and \u0026ldquo;Suspended due to clinical conditions.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe IL-TB system also records sociodemographic and epidemiological data (age, sex, race, residence, TB contact history); clinical data (BCG vaccination, chest X-ray, HIV status, antiretroviral therapy [ART], TST, IGRA); and operational characteristics (type of entry, facility location and type, treatment regimen, prescribing professional, number of doses taken, and treatment closure status). On the basis of these variables, additional operational variables were derived:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLocation of health unit (capital vs. interior, based on municipal codes);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealth service type (exclusively primary health care vs. health services with multiple types of care, including TB control program teams);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLatent TB infection (TBI) investigation test performed (TST or IGRA);\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTBI confirmed by test (TST\u0026thinsp;\u0026ge;\u0026thinsp;5 mm or IGRA positive) and;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eShortened TPT regimen (3HP or 4R vs. 6H/9H).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAll variables and definitions are presented in \u003cb\u003eSupplementary Table\u0026nbsp;1.\u003c/b\u003e\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were summarized using medians and interquartile ranges (IQRs). Categorical variables are presented as absolute and relative frequencies. As appropriate, group comparisons by race and TPT completion status were performed via the Mann\u0026ndash;Whitney U test or Student\u0026rsquo;s t test according to the variable distribution. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was adopted.\u003c/p\u003e \u003cp\u003eSimple and multivariable binomial logistic regression models were used to estimate odds ratios (ORs) with corresponding 95% CIs and p values. Regression models were applied to the entire study population and separately to the Indigenous and Nonindigenous subgroups.\u003c/p\u003e \u003cp\u003eConfounding variables such as age, sex, and TPT indications for PLHIV were retained in the multivariable models. Continuous variables with missing data and those indirectly represented by categorical variables (e.g., number of doses vs. treatment regimen) were excluded. The final multivariable model was selected on the basis of the lowest Akaike information criterion (AIC) and evaluation of multicollinearity via the variance inflation factor (VIF).\u003c/p\u003e \u003cp\u003eModel adequacy and goodness-of-fit were assessed through multiple diagnostics, including inspection of the sigmoid curve (\u003cb\u003eSupplementary Fig.\u0026nbsp;3\u0026ndash;5A\u003c/b\u003e), the deviance goodness-of-fit test (based on a chi-square distribution), Pearson\u0026rsquo;s standardized residuals, the Hosmer\u0026ndash;Lemeshow test, and the simulated standard envelope plot (\u003cb\u003eSupplementary Fig.\u0026nbsp;3\u0026ndash;5B\u003c/b\u003e). These visual assessments are provided in detail in the supplementary material to support the interpretation of model performance. All analyses were conducted via R software (R Development Core Team, 2024).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 5,341 records identified between 2019 and 2023, 4,887 new cases were included in the study. Among them, 3,892 completed TPT (3,691 nonindigenous vs. 201 indigenous), whereas 995 did not (975 nonindigenous vs. 20 indigenous) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eStudy population characteristics\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the characteristics of the study population stratified by self-reported race. A greater proportion of males was observed among Indigenous individuals than among Nonindigenous individuals (56.6% vs. 49.5%; p\u0026thinsp;=\u0026thinsp;0.048). Brazilian nationality was less common among indigenous individuals (89.6% vs. 98.3%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, indigenous individuals more often received TPT in health services located in the interior of the state (52.9% vs. 9.4%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study population stratified according to Race\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e[ALL]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eNonindigenous\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003ec\u003c/sup\u003ep.overall\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4887\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4666\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2451 (50.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2355 (50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (43.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2436 (49.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2311 (49.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e125 (56.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (y):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.737\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e985 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e938 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;= 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3902 (79.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3728 (79.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174 (78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazilian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4785 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4587 (98.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e198 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForeign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e23 (10.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of contact with TB cases:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1999 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1973 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2888 (59.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2693 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e195 (88.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of the Health Unit:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4333 (88.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4229 (90.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e554 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e437 (9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e117 (52.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth services with multiple types of care\u003csup\u003ea\u003c/sup\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2090 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1956 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e134 (60.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2797 (57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2710 (58.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformed test by investigate TBI (TST/IGRA):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e538 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e533 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4349 (89.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4133 (88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e216 (97.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBI confirmed by test (TST/IGRA):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e712 (14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e704 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4175 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3962 (84.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e213 (96.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndication of TPT for PLHIV:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3579 (73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3371 (72.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1308 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1295 (27.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShortened TPT (3HP/4R):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1989 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1898 (40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2898 (59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2768 (59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClosure status of TPT:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e995 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e975 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3892 (79.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3691 (79.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e201 (91.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eTable note \u003csup\u003ea\u003c/sup\u003eServices with different types of health care, not exclusively primary care. \u003csup\u003eb\u003c/sup\u003eNonindigenous race includes white, black, brown or yellow. \u003csup\u003ec\u003c/sup\u003eP-value of the study population.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIL-TB, Information System for Latent Infection by \u003cem\u003eM. tuberculosis\u003c/em\u003e, AM-BR, 2019\u0026ndash;2023.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: PLHIV, person with human immunodeficiency virus; TB, tuberculosis; TBI, tuberculosis infection; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e SD, standard deviation; TST, Tuberculin skin test; IGRA, interferon gamma release assay.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNonindigenous individuals were more likely to receive TPT in services with multiple types of care (58.1%), whereas indigenous individuals more frequently received care exclusively through primary health care services (60.6%). Diagnostic tests (TSTs/IGRAs) for TBI were performed more regularly among indigenous individuals than among nonindigenous individuals (97.7% vs. 88.6%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Indigenous individuals also presented higher rates of TBI confirmation and TB contact history (96.4% vs. 84.9%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and 88.2% vs. 57.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). The proportion of TPT indications for PLHIV was lower among indigenous individuals (5.9% vs. 27.8%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). TPT completion was more common among Indigenous individuals than among Nonindigenous individuals (91.0% vs. 79.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the characteristics of the study population according to TPT completion and race. The overall completion rate was 79.6%, with indigenous individuals demonstrating a higher completion rate (90.9%) than nonindigenous individuals did (79.1%). Unlike what was observed in the total population and among nonindigenous people, men had a higher proportion of complete TPT among indigenous people (56.7%). Individuals under 18 years of age had slightly higher completion rates (20.8% complete vs. 17.6% incomplete; p\u0026thinsp;=\u0026thinsp;0.027). Among adults, the highest proportion of TPT completion was observed among nonindigenous individuals (79.2% vs. 78.1% among indigenous individuals).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study population stratified according to TPT completion and by race\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e[ALL]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eNonindigenous\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003csup\u003ec\u003c/sup\u003ep.overall\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIncomplete\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003cp\u003e(N;%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e995 (20.4)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003e3892\u003c/em\u003e \u003cb\u003e(79.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e975 (20.9)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e3691\u003c/em\u003e \u003cb\u003e(79.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003e20 (9.1)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e201 (90.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e497 (49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1954 (50.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e488 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1867 (50.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e498 (50.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1938 (49.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e487 (49.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1824 (49.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e114 (56.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (y):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e810 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e766 (20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;= 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e820 (82.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3082 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e803 (82.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2925 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e17 (85.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e157 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonindigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e975 (98.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3691 (94.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e201 (5.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrazilian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e959 (96.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3826 (98.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e942 (96.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3645 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e181 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eForeign\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e36 (3.62)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e33 (3.38)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46 (1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3 (15.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of contact with TB cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e448 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1551 (39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e443 (45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1530 (41.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e547 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2341 (60.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e532 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2161 (58.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e180 (89.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of the Health Unit:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e944 (94.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3389 (87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e934 (95.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3295 (89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e503 (12.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (4.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e396 (10.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e107 (53.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth services with multiple types of care\u003csup\u003ea\u003c/sup\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e370 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1720 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e361 (37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1595 (43.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e125 (62.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e625 (62.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2172 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e614 (63.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2096 (56.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e76 (37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerformed test by investigate TBI (TST/IGRA):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e411 (10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e407 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e868 (87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3481 (89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e849 (87.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3284 (89.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e(95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e197 (98.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBI confirmed by test (TST/IGRA):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e173 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e539 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e532 (14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e822 (82.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3353 (86.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e803 (82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3159 (85.6)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e194 (96.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndication of TPT for PLHIV:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e710 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2869 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e690 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2681 (72.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e188 (93.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e285 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1023 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e285 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1010 (27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (6.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShortened TPT (3HP/4R):\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e559 (56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1430 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e545 (55.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1353 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e436 (43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2462 (63.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e430 (44.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2338 (63.3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e124 (61.7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eTable note: \u003csup\u003ea\u003c/sup\u003eServices with different types of health care, not exclusively primary care. \u003csup\u003eb\u003c/sup\u003eNonindigenous race includes white, black, brown or yellow. \u003csup\u003ec\u003c/sup\u003eP-value of the study population.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eIL-TB, Information System for Latent Infection by M. tuberculosis, AM-BR, 2019\u0026ndash;2023.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eAbbreviations: PLHIV, person with human immunodeficiency virus; TB, tuberculosis; TBI, tuberculosis infection; + SD, standard deviation; TST, tuberculin skin test; IGRA, interferon gamma release assay.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBrazilian nationality predominated across all groups, although the proportion of foreign nationals was greater among individuals who did not complete TPT (3.6% vs. 1.70%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). TB contact was more common among individuals who completed TPT (60.1% vs. 55%; p\u0026thinsp;=\u0026thinsp;0.003) and among indigenous individuals than among nonindigenous individuals (89.6% vs. 58.5%). With respect to health unit location, individuals who completed TPT were more frequently treated in interior municipalities (12.9% vs. 5.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a pattern also observed among indigenous participants.\u003c/p\u003e \u003cp\u003eAmong the indigenous individuals who completed TPT, 62.2% received care exclusively for primary health care services, whereas 43.2% of the nonindigenous individuals did. The performance of tests for TBI investigation (TST/IGRA) was high across all groups, with slightly higher proportions among individuals who completed TPT in the general population (89.4%) and among indigenous participants (98.0%). Confirmation of the TBI by test was observed in 86.2% of individuals who completed TPT (p\u0026thinsp;=\u0026thinsp;0.006) and in 96.5% of Indigenous individuals. TPT indications for PLHIV were reported in 26.3% of the completers in the general population and in 6.5% of the Indigenous individuals. The use of shortened TPT regimens (3HP/4R) was more common among all groups who completed TPT, with a significant difference in the general population (63.3% vs. 43.8%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with TPT completion in the study population\u003c/h2\u003e \u003cp\u003eAccording to the adjusted logistic regression model, TPT completion was positively associated with the Indigenous race (OR: 2.4; 95% CI: 1.49\u0026ndash;4.06; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), treatment in health units located in the interior (OR: 2.03; 95% CI: 1.49\u0026ndash;2.82; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the use of shortened TPT regimens (OR: 2.36; 95% CI: 2.04\u0026ndash;2.73; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, foreign nationality (OR: 0.28; 95% CI: 0.18\u0026ndash;0.44; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and receiving care in services with multiple types of care (OR: 0.79; 95% CI: 0.66\u0026ndash;0.94; p\u0026thinsp;=\u0026thinsp;0.008) were associated with lower odds of completing TPT. Additionally, TBI confirmed by TST/IGRA (OR: 1.57; 95% CI: 1.06\u0026ndash;2.31; p\u0026thinsp;=\u0026thinsp;0.022) and TPT indications for PLHIV (OR: 1.31; 95% CI: 1.04\u0026ndash;1.65; p\u0026thinsp;=\u0026thinsp;0.020) were also positively associated with TPT completion \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhen factors associated with TPT completion by subpopulation were analyzed, the adjusted model for indigenous individuals revealed that only the use of the shortened 3HP/4R regimen was significantly associated with completion (OR: 5.75; 95% CI: 1.78\u0026ndash;23.4; p\u0026thinsp;=\u0026thinsp;0.006), as shown in \u003cb\u003eSupplementary Fig.\u0026nbsp;2\u003c/b\u003e. Among nonindigenous individuals, shortened regimens (OR: 2.31; 95% CI: 1.99\u0026ndash;2.68; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), TPT performed in interior municipalities (OR: 2.25; 95% CI: 1.61\u0026ndash;3.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), TBI confirmation (OR: 1.58; 95% CI: 1.06\u0026ndash;2.32; p\u0026thinsp;=\u0026thinsp;0.020), and TPT indication for PLHIV (OR: 1.28; 95% CI: 1.02\u0026ndash;1.61; p\u0026thinsp;=\u0026thinsp;0.036) were all positively associated with treatment completion. Conversely, as observed in the total population, among nonindigenous individuals, being a foreign nation (OR: 0.25; 95% CI: 0.16\u0026ndash;0.41; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and receiving TPT in services with multiple types of care (OR: 0.8; 95% CI: 0.67\u0026ndash;0.96; p\u0026thinsp;=\u0026thinsp;0.018) were associated with lower odds of completion \u003cb\u003e(Supplementary Fig.\u0026nbsp;1)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn Brazil, TPT was not historically prioritized as a central component of TB control. Although incorporated into national guidelines between 2011 and 2018, active case finding remained the primary preventive measure. TPT was mainly recommended for specific groups, such as contacts of laboratory-confirmed pulmonary TB cases, PLHIV, and individuals in areas with better TB indicators and lower treatment interruption rate (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUntil the first half of 2021, the primary regimen available for TPT in Brazil was Isoniazid monotherapy (6H or 9H). Although 4R (four months of daily rifampicin) was also available, its use remained limited to specific populations (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Following the incorporation of 3HP into the public health system in the second half of 2021, this regimen progressively replaced Isoniazid monotherapy and, by the end of 2023, accounted for approximately 50% of TPT initiations nationally. In Amazonas, however, uptake was faster, with 3HP representing around 90% of all TPT initiations (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe rapid implementation of 3HP contributed to its consolidation as the preferred regimen in the Amazonas, a region marked by both high TB burden and the largest Indigenous population in the country, most of whom reside in municipalities located in the interior (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study provides important insights into TPT outcomes in the Brazilian Amazon, revealing high overall completion rates and significantly better adherence among indigenous individuals. These findings challenge the prevailing assumption that indigenous populations consistently experience poorer outcomes due to social vulnerability (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Instead, our data suggest that targeted strategies\u0026mdash;such as shorter regimens and decentralized care delivery\u0026mdash;may have played a pivotal role in improving adherence in these communities.\u003c/p\u003e \u003cp\u003eThe strong association between shortened TPT regimens and completion, particularly among indigenous individuals, reinforces the importance of treatment simplification in enhancing adherence. In our stratified analysis, the use of a short regimen was the only factor significantly associated with completion in the Indigenous subgroup. This aligns with previous literature demonstrating that strong social cohesion and community engagement\u0026mdash;often observed in indigenous populations\u0026mdash;facilitate adherence, especially when culturally adapted interventions and trusted local leaders are involved (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eExtensive global evidence also highlights the disproportionate burden of TB among indigenous peoples and the need for tailored approaches to improve access and outcomes (\u003cspan additionalcitationids=\"CR24 CR25 CR26 CR27\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Our findings contribute real-world programmatic evidence supporting this approach in a high-burden region.\u003c/p\u003e \u003cp\u003e The positive association between TPT completion and care provided in interior municipalities highlights the potential impact of health system decentralization. Recent efforts to expand service delivery beyond capital cities may improve access and program effectiveness, particularly with community-based strategies (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Additionally, TPT completion was greater in services operating exclusively through primary health care (PHC), supporting models emphasizing accessibility, continuity of care, and trust between providers and patients (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, foreign nationality was associated with lower odds of TPT completion, underscoring well-documented barriers faced by migrants and nonnationals, such as limited knowledge about latent TB, stigma, and restricted access to care. Evidence from other high-burden countries suggests that foreign-born individuals may benefit from intensified support strategies, including culturally adapted counseling and directly observed therapy (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). These results emphasize the need for inclusive policies and health services tailored to all vulnerable groups\u0026rsquo; linguistic and cultural needs.\u003c/p\u003e \u003cp\u003eThis study has several limitations. Using secondary data from a programmatic database may involve information bias, including incomplete or inaccurate outcome reporting. Health workers self-identify or classify races, which may not fully capture their sociocultural identity. However, the maintenance of key covariates and the selection of our model on the basis of careful assumptions of fit and adequacy sought to minimize confounding and emphasize the representativeness of the population of our study in the Brazilian Amazon scenario.\u003c/p\u003e \u003cp\u003eDespite these limitations, our findings offer robust real-world evidence that simplified TPT regimens, combined with decentralized and primary healthcare\u0026ndash;based delivery models, can substantially improve treatment completion in high-burden and underserved settings. Indigenous individuals\u0026rsquo; notably high completion rates demonstrate that equity-focused and culturally sensitive interventions can overcome historical barriers and deliver successful TB prevention outcomes. Scaling up access to short-course regimens and strengthening local health systems are critical next steps to advance TB elimination in the Amazon and similar contexts.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOur findings offer robust real-world evidence that simplified TPT regimens, combined with decentralized and primary healthcare\u0026ndash;based delivery models, can substantially improve treatment completion in high-burden and underserved settings. Indigenous individuals\u0026rsquo; notably high completion rates demonstrate that equity-focused and culturally sensitive interventions can overcome historical barriers and deliver successful TB prevention outcomes. Scaling up access to short-course regimens and strengthening local health systems are critical next steps to advance TB elimination in the Amazon and similar contexts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTPT\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tuberculosis Preventive Therapy\u003c/p\u003e\n\u003cp\u003eTB\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tuberculosis\u003c/p\u003e\n\u003cp\u003eTBI\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tuberculosis Infection\u003c/p\u003e\n\u003cp\u003ePLHIV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;People Living with Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eTST\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Tuberculin Skin Test\u003c/p\u003e\n\u003cp\u003eIGRA\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Interferon Gamma Release Assay\u003c/p\u003e\n\u003cp\u003e3HP\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3-month regimen of weekly isoniazid and rifapentine\u003c/p\u003e\n\u003cp\u003e4R\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4-month regimen of daily rifampicin\u003c/p\u003e\n\u003cp\u003eIPT 6H/9H\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Isoniazid Preventive Therapy for 6/9-month regimen of daily isoniazid\u003c/p\u003e\n\u003cp\u003eIL-TB\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Information System for Latent Infection by M. tuberculosis\u003c/p\u003e\n\u003cp\u003eAIC\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Akaike Information Criterion\u003c/p\u003e\n\u003cp\u003eVIF\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Variance Inflation Factor\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence Interval\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Odds Ratio\u003c/p\u003e\n\u003cp\u003eSD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard Deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study used anonymized secondary data from the \u003cem\u003eMycobacterium tuberculosis\u003c/em\u003e Infection Information System, with authorization from the Amazonas Health Surveillance Foundation, as described in the item \u0026quot;Data collection and variable definitions\u0026quot; in the \u0026quot;Methods\u0026quot; section. According to Resolution No. 510, of April 7, 2016, of the National Health Council of Brazil, which governs the ethical standards for research in the Human and Social Sciences in Brazil, obtaining the Informed Consent Form may be waived in cases of use of anonymized secondary data, if it is duly justified and approved by the Research Ethics Committee. The study protocol was approved by the Ethics Committee of the Dr. Heitor Vieira Dourado Tropical Medicine Foundation (CAAE: 74993423.8.0000.0005), with the due dispensation of Informed Consent Form.\u003c/p\u003e\n\u003cp\u003eIn addition, the research was conducted in accordance with the ethical principles set forth in the World Medical Association\u0026apos;s Declaration of Helsinki, which guides medical research involving human subjects, ensuring compliance with relevant national and international ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study will be available upon reasonable request to the corresponding author of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by the intramural Programa de P\u0026oacute;s-Gradua\u0026ccedil;\u0026atilde;o em Medicina Tropical of the Universidade do Estado do Amazonas and Funda\u0026ccedil;\u0026atilde;o de Medicina Tropical Dr. Heitor Vieira Dourado (to JSP, DCBS, LSG, RSG, MCS); the intramural Programa Estadual de Controle da Tuberculose do Amazona of the Funda\u0026ccedil;\u0026atilde;o de Vigil\u0026acirc;ncia em Sa\u0026uacute;de do Amazonas Dra. Rosemary Costa Pinto (to LBOA, IPS); and the intramural Instituto de Pesquisa em Popula\u0026ccedil;\u0026otilde;es Priorit\u0026aacute;rias (IRPP), Instituto MONSTER de Ensino, Assist\u0026ecirc;ncia, Pesquisa e Desenvolvimento Tecnol\u0026oacute;gico em Sa\u0026uacute;de (to\u0026nbsp;BBD, KVS, MMR, BBA). JSP and LSG received a fellowship from the Coordena\u0026ccedil;\u0026atilde;o de Aperfei\u0026ccedil;oamento de Pessoal de N\u0026iacute;vel Superior [Case number: 88887.802821/2023-00 and 88887.148541/2025-00, respectively]. BBA and MCS are fellows from the Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e JSP, BBD, BBA, MCS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData verification and curation:\u003c/strong\u003e JSP, LBOA, BBD, RSG, LSG, BBA, MCS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation:\u003c/strong\u003e JSP, LBOA, BBD, KVS, MMR, BBA, MCS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFormal analysis:\u003c/strong\u003e JSP, LBOA, IPS, BBD, MMR, RSG, DCBS, LSG, KVS, BBA, MCS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding acquisition:\u003c/strong\u003e JSP, BBA, MCS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e JSP, BBD, KVS, MMR, BBA, MCS.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the institutions that contributed to the study: the Universidade do Estado do Amazonas (UEA), which is in broad agreement with the Funda\u0026ccedil;\u0026atilde;o de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD); the Funda\u0026ccedil;\u0026atilde;o de Vigil\u0026acirc;ncia em Sa\u0026uacute;de do Amazonas Dra. Rosemary Costa Pinto (FVS-RCP); the Secretaria Municipal de Sa\u0026uacute;de de Manaus-AM (Semsa); the Instituto de Pesquisa em Popula\u0026ccedil;\u0026otilde;es Priorit\u0026aacute;rias (IRPP), Instituto MONSTER de Ensino, Assist\u0026ecirc;ncia, Pesquisa e Desenvolvimento Tecnol\u0026oacute;gico em Sa\u0026uacute;de; the Superintend\u0026ecirc;ncia da Zona Franca de Manaus (Suframa); the Funda\u0026ccedil;\u0026atilde;o de Amparo \u0026agrave; Pesquisa do Estado do Amazonas (FAPEAM); the Coordena\u0026ccedil;\u0026atilde;o de Aperfei\u0026ccedil;oamento de Pessoal de N\u0026iacute;vel Superior (CAPES) and the Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico (CNPq).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. WHO global tuberculosis report 2024 [Internet]. Geneva: WHO; 2024. 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A shorter treatment regimen for latent tuberculosis infection holds promise for at-risk Canadians. \u003cem\u003eCan Commun Dis Rep.\u003c/em\u003e 2017;43(3/4):67\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eBorse R, Randive B, Mattoo S, Malik P, Solanki H, Gupta A, et al. Three months of weekly rifapentine plus isoniazid for TB prevention among people with HIV. \u003cem\u003eIJTLD Open. 2024\u003c/em\u003e;1(9):404\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eSterling TR, Scott NA, Mir\u0026oacute; JM, Calvet G, La Rosa A, Infante R, et al. Three months of weekly rifapentine plus isoniazid for treatment of \u003cem\u003eM. tuberculosis\u003c/em\u003e infection in HIV coinfected persons. \u003cem\u003eAIDS\u003c/em\u003e. 2016;30(10):1607\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eBrasil. \u003cem\u003eBoletim Epidemiol\u0026oacute;gico \u0026ndash; Tuberculose 2024\u003c/em\u003e. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2024. Available from: https://www.gov.br/aids/pt-br/central-de-conteudo/boletins-epidemiologicos/2024/boletim-epidemiologico-tuberculose-2024/view\u003c/li\u003e\n\u003cli\u003eSouza JE, Costa CA, Fran\u0026ccedil;a GP, Alonso N, et al. Difficulties in accessing medical surgical care in the Amazonas. In: Mikkola H, editor. \u003cem\u003eAmazon Ecosystem - Past Discoveries and Future Prospects\u003c/em\u003e. London: IntechOpen; 2023. doi:10.5772/intechopen.1003082\u003c/li\u003e\n\u003cli\u003eTeibo TKA, Andrade RL, Rosa RJ, Abreu PD, Olayemi OA, Alves YM, et al. Barriers that interfere with access to tuberculosis diagnosis and treatment across countries globally: a systematic review. \u003cem\u003eACS Infect Dis.\u003c/em\u003e 2024;10(8):2600\u0026ndash;14. doi:10.1021/acsinfecdis.4c00466\u003c/li\u003e\n\u003cli\u003ePetruccelli JL, Saboia AL, orgs. 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Minist\u0026eacute;rio da Sa\u0026uacute;de. Secretaria de Vigil\u0026acirc;ncia em Sa\u0026uacute;de. Departamento de Vigil\u0026acirc;ncia Epidemiol\u0026oacute;gica. \u003cem\u003eManual de recomenda\u0026ccedil;\u0026otilde;es para o controle da tuberculose no Brasil\u003c/em\u003e. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2011. 284 p. (S\u0026eacute;rie A. Normas e Manuais T\u0026eacute;cnicos). ISBN: 978-85-334-1816-5. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_recomendacoes_controle_tuberculose_brasil.pdf\u003c/li\u003e\n\u003cli\u003eBrasil. Minist\u0026eacute;rio da Sa\u0026uacute;de. Secretaria de Vigil\u0026acirc;ncia em Sa\u0026uacute;de. Departamento de Vigil\u0026acirc;ncia das Doen\u0026ccedil;as Transmiss\u0026iacute;veis. \u003cem\u003eProtocolo de vigil\u0026acirc;ncia da infec\u0026ccedil;\u0026atilde;o latente pelo Mycobacterium tuberculosis no Brasil\u003c/em\u003e. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2018. 32 p. ISBN: 978-85-334-2650-4. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/protocolo_vigilancia_infeccao_latente_mycobacterium_tuberculosis_brasil.pdf\u003c/li\u003e\n\u003cli\u003eBasta PC, Viana PV. Determinants of tuberculosis in Indigenous people worldwide. \u003cem\u003eLancet Glob Health\u003c/em\u003e. 2018;6(6):e678\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eAndrade SR, Vidor AC, Ribeiro JC, Ribeiro CEP. Indicadores e rede de aten\u0026ccedil;\u0026atilde;o: uma experi\u0026ecirc;ncia do Programa de Educa\u0026ccedil;\u0026atilde;o pelo Trabalho em Vigil\u0026acirc;ncia em Sa\u0026uacute;de. \u003cem\u003eInterface (Botucatu)\u003c/em\u003e. 2015;19(Supl 1):913\u0026ndash;22. doi:10.1590/1807-57622014.0826.\u003c/li\u003e\n\u003cli\u003eBetancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. \u003cem\u003ePublic Health Rep\u003c/em\u003e. 2003;118(4):293\u0026ndash;302. doi:10.1093/phr/118.4.293.\u003c/li\u003e\n\u003cli\u003eBasta PC, Rios DPG, Alves LCC, Sant\u0026rsquo;Anna CC, Coimbra Jr CEA. Estudo cl\u0026iacute;nico-radiol\u0026oacute;gico de crian\u0026ccedil;as e adolescentes ind\u0026iacute;genas Suru\u0026iacute;, regi\u0026atilde;o amaz\u0026ocirc;nica. \u003cem\u003eRev Soc Bras Med Trop.\u003c/em\u003e 2010;43(6):719\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eLitvinjenko S, Magwood O, Wu S, Wei X. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. \u003cem\u003eLancet Infect Dis\u003c/em\u003e. 2023;23(10):e352\u0026ndash;61.\u003c/li\u003e\n\u003cli\u003eEisenbeis L, Gao Z, Heffernan C, Yacoub W, Long R, Verma G. Contact investigation outcomes of Canadian-born adults with tuberculosis in Indigenous and non-Indigenous populations in Alberta. \u003cem\u003eCan J Public Health\u003c/em\u003e. 2016;107(1):e106\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eDehghani K, Lan Z, Li P, Michelsen SW, Waites S, Benedetti A, et al. Determinants of tuberculosis trends in six Indigenous populations of the USA, Canada, and Greenland from 1960 to 2014: a population-based study. \u003cem\u003eLancet Public Health\u003c/em\u003e. 2018;3(3):e133\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eGopie FA, Hassankhan A, Ottevanger S, Krishnadath I, de Lange W, Zijlmans CWR, et al. Ethnic disparities in tuberculosis incidence and related factors among Indigenous and other communities in ethnically diverse Suriname. \u003cem\u003eJ Clin Tuberc Other Mycobact Dis\u003c/em\u003e. 2021;23:100227.\u003c/li\u003e\n\u003cli\u003eMalacarne J, Kolte IV, Freitas LP, Orellana JDY, Souza MLP, Souza-Santos R, et al. Factors associated with TB in an Indigenous population in Brazil: the effect of a cash transfer program. \u003cem\u003eRev Inst Med Trop Sao Paulo\u003c/em\u003e. 2018;60:e63.\u003c/li\u003e\n\u003cli\u003eTeixeira MG, Costa MCN, Paix\u0026atilde;o ES, Carmo EH, Barreto FR, Penna GO. Conquistas do SUS no enfrentamento das doen\u0026ccedil;as transmiss\u0026iacute;veis. \u003cem\u003eCi\u0026ecirc;nc Sa\u0026uacute;de Coletiva\u003c/em\u003e. 2020;25(4):1237\u0026ndash;46.\u003c/li\u003e\n\u003cli\u003eMendes EV. As redes de aten\u0026ccedil;\u0026atilde;o \u0026agrave; sa\u0026uacute;de. Bras\u0026iacute;lia: Organiza\u0026ccedil;\u0026atilde;o Pan-Americana da Sa\u0026uacute;de (OPAS); 2011.\u003c/li\u003e\n\u003cli\u003ePease CP, Alvarez GG. A shorter treatment regimen for latent tuberculosis infection holds promise for at-risk \u003cem\u003eCanadians. Can Commun Dis Rep.\u003c/em\u003e 2017;43(3/4):67\u0026ndash;71. Available from: https://pubmed.ncbi.nlm.nih.gov/29770067/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Healthcare disparities, Primary health care, Program evaluation","lastPublishedDoi":"10.21203/rs.3.rs-6811654/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6811654/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTuberculosis preventive therapy (TPT) is crucial for preventing the progression from TB infection (TBI) to active disease, particularly among vulnerable populations such as indigenous people. Although shorter regimens have improved adherence, evidence from real-world programmatic settings is limited. This study evaluated whether the indigenous race was associated with greater TPT completion in the Brazilian Amazon.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study using data from the IL-TB database (2019\u0026ndash;2023) in Amazonas, Brazil. Individuals who initiated TPT were stratified by race. The primary outcome was TPT completion. Multivariate logistic regression identified factors associated with completion, adjusting for sociodemographic, clinical, and operational variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 4,887 individuals, 79.6% completed TPT. Completion was higher among Indigenous individuals (90.9%) than among Nonindigenous individuals (79.1%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the adjusted analysis, indigenous race (OR: 2.4; 95% CI: 1.49\u0026ndash;4.06), shortened TPT regimens (OR: 2.36; 95% CI: 2.04\u0026ndash;2.73), and receiving care in noncapital municipalities (OR: 2.03; 95% CI: 1.49\u0026ndash;2.82) were positively associated with completion. Foreign nationality (OR: 0.28; 95% CI: 0.18\u0026ndash;0.44) and TPT nonexclusive primary health care services (OR: 0.79; 95% CI: 0.66\u0026ndash;0.94) were negatively associated with such outcomes. Among nonindigenous individuals, associations mirrored those in the overall population. Among Indigenous individuals, only a shortened regimen was significantly associated with completion (OR: 5.75; 95% CI: 1.78\u0026ndash;23.4).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIndigenous individuals presented greater TPT completion, particularly when treated with shortened regimens. These findings reinforce the potential of decentralized strategies and the use of shortened regimens to increase the completeness of tuberculosis preventive therapy and provide evidence for overcoming historical and operational barriers at the program level that still prevail and delay the improvement of public policies aimed at achieving global TB elimination goals, especially in high-burden settings, social inequality and the strong presence of vulnerable populations.\u003c/p\u003e","manuscriptTitle":"Completeness of preventive therapy for tuberculosis in indigenous versus nonindigenous populations in the Brazilian Amazon: a retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-11 08:32:34","doi":"10.21203/rs.3.rs-6811654/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-15T04:40:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-11T18:29:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-10T09:53:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-09T09:34:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-07T20:31:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T14:37:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269140807580029900729758364057748780132","date":"2025-06-28T11:26:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38362151704560614865300366695625028944","date":"2025-06-26T11:51:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15592253371988184128949806348542948424","date":"2025-06-25T12:54:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T04:56:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149094225292698733607550827641742188684","date":"2025-06-24T17:16:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202305709686242178858270943595152121588","date":"2025-06-24T14:37:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151229803065805236084886170762348764328","date":"2025-06-24T12:54:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32681936559947738721105242008728244747","date":"2025-06-24T09:44:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54986792824337898622919645576256248806","date":"2025-06-20T14:53:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-19T14:22:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-10T05:23:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-10T00:15:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-10T00:14:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-03T12:58:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2bca87fe-e3f7-4713-9670-56d2d72390f1","owner":[],"postedDate":"June 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-10T15:31:52+00:00","versionOfRecord":{"articleIdentity":"rs-6811654","link":"https://doi.org/10.1186/s12889-025-25177-8","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-12-02 15:58:13","publishedOnDateReadable":"December 2nd, 2025"},"versionCreatedAt":"2025-06-11 08:32:34","video":"","vorDoi":"10.1186/s12889-025-25177-8","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25177-8","workflowStages":[]},"version":"v1","identity":"rs-6811654","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6811654","identity":"rs-6811654","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}