The increase in notifications of drug-resistant tuberculosis (DR-TB) in Brazil reflects failures in diagnosis and treatment, and the impact of social determinants of health, such as poverty, low educational level, and social vulnerability. With high rates of treatment interruption and unfavorable outcomes, understanding the epidemiological profile of DR-TB is essential to develop more effective control strategies. To describe the sociodemographic, clinical-laboratory, and therapeutic profile of DR-TB cases. A descriptive and retrospective study with 1,826 DR-TB cases in the state of São Paulo, using SITETB data from 2013–2023, with analysis of clinical, sociodemographic, and therapeutic variables. Male individuals represented 72.3% of cases, with a mean age of 39.2 years; 41.6% self-declared as White, and 50.3% as Black and mixed race. A total of 61.6% had 4 to 11 years of schooling, and 7.9% had 12 years or more. Among the cases, 17.5% were unemployed, 3% were deprived of liberty, and 1.1% were experiencing homelessness. The pulmonary form predominated (93.3%), with bilateral and unilateral cavitary presentations being the most frequent, at 13% and 11.3%, respectively. The initial resistance pattern included monoresistance (32%), multidrug resistance (25.4%), polyresistance (3.9%), extensive resistance (1.5%), and isolated resistance to rifampicin (37.2%). Longitudinal analysis demonstrated worsening of the resistance pattern. TB-HIV coinfection was recorded in 17% of cases, and 13.3% had no testing. Directly observed treatment was applied in 53.6% of cases. Regarding outcomes, 38.8% progressed to cure, 22.8% interrupted treatment, and 4.5% died. A reduction in the rate of complete treatment was observed between 2016 and 2020 (from 65.4% to 53.2%), with an increase in the proportion of treatment interruption and deaths. DR-TB in São Paulo is a public health challenge, with predominance among young men in situations of social vulnerability and low educational level, a profile associated with higher rates of treatment abandonment. Persistently high resistance levels and low adherence to directly observed treatment indicate structural failures in care, from primary healthcare to tertiary centers. The concentration of cases in urban centers and the frequency of HIV coinfection accentuate the complexity of the scenario and the need for intersectoral responses. The 223 new cases in 2024, with no trend toward reduction, reinforce a possible worsening of the problem. Therefore, strengthening active surveillance strategies, expanding access to and adherence to treatment, and articulating public policies to address the social determinants of the disease are imperative as central elements to contain the expansion of the disease.
Vaz-Curado et al. (2026) studied this question.