The results regarding the socio-demographic profile of the TB patients interviewed seem to be similar to those found in most national and international scientific literature, reinforcing the relationship between the disease and social vulnerability , demonstrating that the disease mostly affects males and individuals with intermediate education levels [17–19].
The organization of TB patient care in the study cities presented heterogeneity, with treatment coexisting at two types of health services, predominantly medical consultations for treatment at TRC. Some authors reveal that regional disparities and social inequality are strong elements that corroborate the diversity in care delivery in the Brazilian scenario [4, 20].
The expansion of the FHS by itself does not guarantee the sustainability of TB control actions in PHC, but a political commitment of managers is necessary , through an integrated approach in the health system, which requires permanent and sustained PHC actions . High coverage of FHS did not influence cities' performance in TB care.
The frequency and site where DOT is performed varied among cities, with greater DOT coverage in cities in the Southeast. Of the five cities, only one (RP) provided DOT at the patients' home. The other cities with higher FHS coverage could present a better performance; however, treatment is conducted at TRC, without establishing partnerships with PHC services, which are provided with Community Health Workers to accomplish this activity. Studies in Brazil have identified that there is a shortage of financial and human resources with appropriate profile to work focused on a community approach and operational difficulties in the use of DOT for most patients under treatment .
In this study, predominance of TB treatment at TRC was determinant for poor performance on some "access to treatment" indicators. Such indicators could be addressed through the insertion of TB program actions at PHC services, which are closest to patients' home. Although the medication is free of charge, indirect costs and losses, such as transport and wages lost, respectively, may turn treatment unfeasible and follow-up difficult .
To overcome this impasse, some countries propose a health system that combines an outpatient referral unit, a defined team for specialized management at district level, which is responsible for treatment, supervision and monitoring, including PHC participation and responsibility in case search and Directly Observed Therapy (DOT) supervision activities. They also recommend a balance between integration, specificity and decentralization and centralization functions, as well as the inclusion of innovative approaches for specialized groups .
All study sites achieved a satisfactory performance on indicators for the dimension "bond". As TRC professionals attend to specific clients in response to a programmed demand, they can dedicate more time to individual case management and understanding of TB patients' singularity. These aspects permit the development of shared responsibilities between patients and health care professionals and the acknowledgement of individual subjectivities involved in the care process  and indicate that the "bond" could be more related to the relationship the user establishes with the health service than to the service location in the geographic area.
The dimension "range of services" was evaluated as regular in the five cities, showing that patients face a lack of social support and collective actions. In daily TB treatment situations, even simple cases require the involvement of great care complexity. They demand epidemiological surveillance, clinical actions supported by therapeutic techniques and by integration between individual and collective care, curative and preventive actions, and care and educative activities . Health teams' performance requires more than a clinical approach, and also needs a policy that guarantees the insertion of TB control actions in the health system .
The dimension "coordination" was well evaluated in its three indicators and reflects health care professionals' concern related to patient follow-up. For a more detailed analysis of this dimension, other elements are required, such as the analysis of health care service integration, information system quality and reference mechanisms.
The accomplishment of family-focused actions was evaluated as regular in the cities with high PHC coverage, in contrast with a better evaluation in RP and SJRP. This fact highlights the need to involve family members in the TB patient care process and also include them as an object of care. PHC professionals can accomplish this, have this responsibility and should be included in TB care.
Despite facing the significant implantation and expansion process of the FHS in Brazil, the dominance of the traditional healthcare model is still clear [29, 30]. In the country, tools to encourage the incorporation of epidemiological surveillance actions in the PHC context "are not always directed to induce a greater integration of the various levels of complexity of care" .
The transition from the conventional model of the TRC to the PHC services was identified in some cities, as well as the importance of integrating both. The decentralization of TB control actions to PHC in countries whose health systems have not been consolidated yet demands caution, as it can result in diluted responsibilities, lack of commitment, low quality or lack of laboratory support, fragmentation of treatment regimens and programs, difficulties to accomplish DOT and flaws in information systems capable of providing reliable reports .
Therefore, TRC should act as a support for training, supervision, monitoring and evaluating TB care at the different health system levels. Thus, specific technologies for TB patient treatment and care could be guaranteed, integrating them with other PHC attributes and promoting co-responsibility at all healthcare levels. The struggle for political spaces, ideological and technological aspects  remain as obstacles for the achievement of health service integration.
Some limitations and difficulties that were identified in this study are related to the organizational characteristics of the health system and TB care in the cities and to the method (sample size for each city, interviews in violent areas that required the presence of a health care professional, difference in treatment conduction among sites (centralized and decentralized services) and the instrument that needed to be readapted for each treatment organization mode. An operational and epidemiological TB research group enhanced the project development, which works in an integrated way within cities and health services.