Despite the widespread use of smartphones and messaging applications, the acceptance of VDOT remains limited among individuals undergoing tuberculosis treatment in São Paulo. Effective implementation strategies must go beyond technological availability and incorporate culturally sensitive, educational, and patient-centered approaches to support digital adherence.

The analysis revealed mismatches between the scale of program execution and the quality of support continuity. Identifying municipalities with low coverage and high programmatic impact is crucial to reorient intersectoral strategies and ensure continuity of patient-centered TB care.

Findings reveal critical gaps in the normative landscape of social protection for people affected by TB in Rio de Janeiro. The lack of explicit policies and integration between health and social sectors may hinder treatment adherence and equity. Strengthening local governance and institutionalizing targeted social support are urgent to align municipal policies with global TB control strategies and protect vulnerable populations from avoidable hardship.