The study reveals higher loss to follow-up rates in men, but when considering gender and HIV co-infection, interruptions are more common in women. Regional variations in LTFU were observed. The findings emphasize gender differences in treatment outcomes and the need for tailored interventions and integrated approaches between TB and HIV.

The findings reveal a substantial impact of the COVID-19 pandemic on TB mortality in Brazil, with regional variations highlighting differential vulnerabilities. The excess mortality observed underscores the need for strengthened TB surveillance and recovery strategies, especially in regions disproportionately affected. Bayesian time series models provide a robust framework for evaluating long-term consequences of public health crises on endemic diseases such as TB.

The COVID-19 pandemic functioned as a policy accelerator, driving the rapid creation of social protection norms. However, the post-pandemic decline underscores the fragility of emergency-driven initiatives and the lack of institutionalization of long-term policies. Strengthening the integration of social protection into TB control strategies requires the transition from reactive to permanent, structured policy responses. Ensuring continuity beyond crises is critical to address social determinants and reduce TB vulnerability sustainably.

The unequal distribution of social protection policy production reveals structural differences in institutional capacity and political will across municipalities. These disparities may undermine TB care continuity, especially in vulnerable regions. To address this, regionalized technical support and federative coordination strategies should be prioritized to reduce normative gaps and promote equitable policy action. Strengthening local governance capacity is essential to ensure all high-burden municipalities are equipped to implement and sustain TB-related social protection measures.