Análise do discurso dos gestores relacionado às dificuldades enfrentadas acerca da transferência de política do tratamento diretamente observado da tuberculose

Abstract

Tuberculosis (TB) remains an important public health problem in Brazil and in the world, especially in contexts marked by social inequalities and difficulties in accessing health services. Among the recommended strategies for disease control is the Directly Observed Treatment (TDO), considered a health technology aimed at strengthening adherence to treatment and reducing therapeutic abandonment. In this context, it becomes relevant to understand how the transfer of this policy to health services occurs and what difficulties are faced in the process of its implementation. Thus, the present study aimed to analyze the discourse of managers of primary health care (PHC) related to the difficulties faced regarding the policy transfer (TP) of the TB TDO in the city of João Pessoa, Paraíba. This is an exploratory research, with a qualitative approach, based on the Discourse Analysis (AD) of the French line. 15 managers linked to the PHC of the municipality participated in the study, including managers of Family Health Units (FHU) and coordination of the TB Control Program. Data collection occurred between December 2025 and February 2026, through semi-structured interviews, later transcribed and analyzed with the help of the ATLAS.ti software. The analysis of the discourses allowed to identify six discursive formations related to the difficulties in the PT of the TDO: User accountability; Social vulnerability as a condition of adhesion; Transfer understood as technical-administrative flow; Organizational fragilities in services; Food incentive as a retention strategy; and Dilution of policy transfer in ignorance or denial. The results show that, although treatment abandonment is often attributed to user behavior, structural factors are also recognized, such as social vulnerability, precariousness of living conditions and organizational limitations of health services. It was also observed that the PT process tends to be understood predominantly as a transfer of rules and administrative flows, with little problematization of its political-institutional dimension. It is concluded that the difficulties related to the implementation of the TDO go beyond the individual plan, being influenced by social, organizational and institutional factors. Thus, the importance of strengthening management processes, professional training and intersectoral articulation is highlighted, considering the specificities of the territories and the living conditions of people affected by TB, in order to improve disease control strategies within the scope of PHC.