Tuberculosis in the South America's homeless: a systematic review of social determinants, control strategies and health equity.
Eliza Miranda Ramos, Carolina Braga Sisti, Sérgio Beltrão de Andrade Lima and 4 others
PMID 42112723WHAT IT FOUND
Homeless people with tuberculosis in South America had high treatment abandonment and mortality.
Directly observed therapy was reported to increase cure rates, but access and social barriers were uneven.
Key findings
01One included study reported that DOT increased cure rates from 54% to 67% among homeless people with TB.
02DOT was performed in only 22% of homeless TB patients in one Brazilian study, with high abandonment and mortality.
03The review identified lack of social protection, treatment abandonment, and extreme poverty as the most frequently reported determinants.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review synthesised mostly observational and descriptive studies, not randomised trials, so it cannot prove that DOT or social programmes caused the reported outcome changes. Many included studies were from Brazil, and remote or border regions were underrepresented, so the evidence may not apply evenly across South America. Few studies evaluated DOT strategies, temporary housing, cultural factors, or climate-related barriers. The review excluded low-quality studies and only included articles in Portuguese, English, or Spanish from 2013 to 2023, so relevant evidence may have been missed.
Declared interests
The review reports financial support from Ministério da Ciência e Tecnologia, Inovações e Comunicações (MCTIC) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq); no competing interests are stated.
The easy way to misread this
Do not conclude that DOT alone will fix treatment failure in homeless people with TB. The review reports DOT coverage was low, and outcomes were also tied to poverty, substance use, stigma, HIV, and weak social protection.