Fifteen years of tuberculosis and HIV diagnostic services in Brazil: disruption, regional disparities, and recovery before, during, and after the COVID-19 pandemic.

Objectives: This study analyzes fifteen years of nationwide trends and regional disparities in tuberculosis (TB) and HIV diagnostics in Brazil, examining the impacts of the COVID-19 pandemic and the uneven recovery of diagnostic services across different regions. Methods: This nationwide ecological study analyzed monthly data on TB and HIV diagnostic tests performed in Brazil from 2010 to 2024, utilizing real-world data. Temporal trends and interrupted time-series analyses evaluated the immediate and progressive effects of the COVID-19 pandemic. Spatial patterns and autocorrelation were explored using bivariate Moran's I and Kernel density estimation. Results: Results showed significant abrupt declines during the COVID-19 pandemic for smear microscopy (-16.4%), culture (-21.4%), and HIV (-16.2%). Post-pandemic, Xpert MTB/RIF showed the highest monthly increase (+3.8%; 95% confidence interval: 2.9-4.7), while smear microscopy declined (-1.2%; 95% confidence interval: -2.0 to -0.5). Spatial analysis revealed pronounced regional heterogeneity, with Northern and Northeastern municipalities facing the greatest disruptions. The Xpert MTB/RIF test demonstrated greater resilience, with evident growth in its distribution and implementation over time. However, this increase resulted in a decrease in the conduction of smear microscopy tests and highlighted territorial disparities, since only 167 municipalities (3%) have Xpert MTB/RIF assays, mainly in the Southeast. Conclusions: COVID-19 significantly disrupted traditional TB and HIV diagnostics in Brazil, while there was an evident increase and resilience of Xpert MTB/RIF, reducing the use of smear microscopy tests. Policy efforts should prioritize the equitable expansion of molecular diagnostic technologies across all regions. This approach will improve early TB detection and drug resistance testing, thereby reducing diagnostic disparities and strengthening health system resilience toward achieving the End TB Strategy.