Clinical, social, and operational determinants of tuberculosis persistence in the Federal District (2013–2025): an integrative review with an ecological approach

Abstract

Objective: To analyze the clinical, social, and operational factors associated with the persistence of high tuberculosis rates in Brazil’s Federal District between 2013 and April 2025. Methods: This is an ecological study based on an integrative literature review. A total of 20 original articles published between 2013 and 2025 were included, selected from SciELO, Scopus, and PubMed databases, using thematic relevance, practical-theoretical scope, and methodological rigor as inclusion criteria. Articles were validated through dual reading and thematic analysis. Results: Findings indicate that the sustained tuberculosis burden in the Federal District stems from the intersection of social vulnerabilities (low income, limited schooling, household overcrowding), structural weaknesses, and operational barriers such as underreporting, low adherence to chemoprophylaxis, and disrupted epidemiological surveillance—worsened during the COVID-19 pandemic. Socioeconomic factors account for up to 70% of the variability in infection and mortality indicators. Conclusion: Tuberculosis in the Federal District represents a multifaceted structural crisis that transcends biomedical boundaries. The study underscores the urgency of integrated public policies that combine social protection, territorialized surveillance, expanded diagnostic coverage, and strengthened primary health care.