PT - JOURNAL ARTICLE AU - Alexandra Brito Souza AU - María B Arriaga AU - Gustavo Amorim AU - Mariana Araújo-Pereira AU - Betânia M F Nogueira AU - Artur T L Queiroz AU - Marina C Figueiredo AU - Michael S Rocha AU - Aline Benjamin AU - Adriana S R Moreira AU - Jamile G Oliveira AU - Valeria Rolla AU - Betina Durovni AU - José R Lapa e Silva AU - Afrânio L Kritski AU - Solange Cavalcante AU - Timothy Sterling AU - Bruno B Andrade AU - Marcelo Cordeiro-Santos ED - , TI - Determinants of losses in the latent tuberculosis infection cascade of care in Brazil AID - 10.1136/bmjgh-2021-005969 DP - 2021 Sep 01 TA - BMJ Global Health PG - e005969 VI - 6 IP - 9 4099 - http://gh.bmj.com/content/6/9/e005969.short 4100 - http://gh.bmj.com/content/6/9/e005969.full SO - BMJ Global Health2021 Sep 01; 6 AB - Introduction Factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil.Methods Close contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6–24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade.Results Among 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/pardo (brown) race were independently associated with losses in the cascade.Conclusion There were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.Data are available upon reasonable request. Data Availability Statement: Due to ethical restrictions regarding participant's privacy, data are available upon request. Data are available upon request for researchers who meet the criteria for access to confidential data. Additional requests for the data may be sent to the corresponding author Marcelo Cordeiro-Santos (marcelocordeiro.br@gmail.com).