Iniquidades raciais no acesso ao diagnóstico da tuberculose na atenção primária à saúde: invisibilidade e desafios enfrentados pela população negra

Abstract

This study aims to analyze access to tuberculosis diagnosis among the Black population within Primary Health Care services, considering the social, institutional, and territorial factors that shape the care process. This is a qualitative, exploratory, and descriptive study conducted through semi-structured interviews with individuals undergoing treatment for tuberculosis. Data analysis was carried out using thematic analysis, grounded in the theoretical framework of justice as fairness proposedby John Rawls (2008) and its extension to health by Daniels (2008). The results indicate that diagnosis occurs predominantlyat a late stage, mediated by fragmented and non-linear therapeutic itineraries, marked by the centrality of urgency and Emergency care services. Limited involvement of Primary Health Care in early case detection was observed, revealing weaknesses in territorial surveillance, care coordination, and integration between primary care and epidemiological surveillance. Participants' narratives highlight the invisibility of early symptoms, discontinuity of follow-up, and limitations in active case-finding strategies. Despite these shortcomings, users expressed a positive evaluation of the services, particularly regarding relational dimensions of care, such as welcoming practices and the establishment of bonds, revealing a tension between recognition and critique. The analysis demonstrates that access to diagnosis is shaped by social determinants and racial inequalities, with structural racism emerging as a central factor in the production of inequities. In light of the theory of justice as fairness, it is concluded that such inequalities compromise the guarantee of fair equality of opportunity in access to healthcare. Diagnostic delay is therefore understood as an expression of structural limitations of Primary Health Care rather than the result of individual choices. The study highlights the need to strengthen Primary Health Care, with emphasis on active surveillance, longitudinal follow-up, and the addressing of social and racial inequalities, in alignment with the principles of equity and social justice.