Case Study for the GTBC Library - TB Prevention Briefing 2025
- Global TB Caucus
- 5 hours ago
- 3 min read
BRAZIL
84,308 | Number of new people with TB notified with TB in Brazil in 2024 |
147% | Increase in tuberculosis preventive treatment (TPT) coverage between 2019 and 2024 |
16% | TPT coverage among household contacts of people with TB in 2024 |
Dr Fernanda Dockhorn Costa is the General Coordinator of Brazil’s National Tuberculosis Programme and an expert panel member for the Global TB Caucus’ new library briefing on tuberculosis (TB) prevention. Here, she outlines her team’s effort to expand access to TB preventive treatment in Brazil, a high TB burden country with one of the largest universal public health systems in the world.
The long road
When TB preventive treatments (TPT) first became available in the 1950s, their use was very limited because of operational and adherence problems with regimens that were long, toxic and costly. In 1998, a national policy of offering 6-9 month isoniazid preventive treatment to people living with HIV and children was adopted, and expanded to all household contacts in 2011.
A national monitoring system was introduced in 2018, enabling the National TB Programme to finally track how many people were accessing TPT and what interventions were increasing uptake. This was promptly followed in 2020 by the introduction of newer diagnostic tests and a much shorter 3-month TPT regimen with rifapentine and isoniazid (3HP). In 2022, 3HP was adopted as the first-choice TPT regimen in Brazil.
Targeted efforts deliver results
Integrating specific TPT objectives into Brazil’s National Strategic Plan set the foundation for a range of interventions, not limited to improved surveillance and newer tools. Care algorithms were revised, healthcare professionals were trained, and scientific and operational research on how to expand TPT coverage was supported. In 2024, prescription rights were expanded to nurses and pharmacists in an attempt to make TPT even more accessible.
The results speak for themselves. Between 2019 and 2024, Brazil has recorded a 147% increase in the number of people accessing TPT. In 2024, over 54,000 people were enrolled in TPT, with more than 70% taking the newer, shorter 3HP regimen. Overall, in 2024, more than 70% of treatments were completed, regardless of the regimen.
Multi-sectoral action the way forward
Dr Fernanda Dockhorn Costa and her team are continuing to seek ways to increase TPT coverage. This increasingly relies on working with other health programmes and ministries. Launched in 2024, a new national incentive fund transfers a total of R$100 million (around US$20 million) to states and municipalities, complementing local budgets to strengthen surveillance and intensify the TB response, including prevention. In 2024, Brazil’s Federal Government launched a new initiative, ‘Healthy Brazil’, which brings together 13 ministries and civil society to address the social determinants that underlie people’s vulnerability to TB and other diseases linked to social determinants.
A major priority for the year ahead is developing an integrated strategy for providing TPT to people deprived of liberty in correctional facilities, where rates of TB remain very high. The introduction of a 1-month TPT regimen with rifapentine and isoniazid (1HP) will be a cornerstone of these efforts.
The importance of parliamentary action
Established in 2012, the National TB Caucus of Brazil (Frente Parlamentar pela Luta Contra A Tuberculose no Brasil) brings together 200 federal deputies and senators.
Dr Fernanda Dockhorn Costa credits the group with monitoring the implementation of public policies, bringing attention to budget allocations and investment priorities for the TB response, and serving as a political platform to foster interministerial coordination in advancing TPT and broader TB control efforts.
This case study was developed to complement the new Global TB Caucus Library Briefing on TB Prevention. To find out more about why TB prevention matters, and what parliamentarians can do to increase access to these life-saving tools , click here.
The data presented in this case study was shared by the National TB Programme of Brazil and drawn from the WHO Global TB Report.
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