Investigating Outcomes of Adolescents and Young Adults (10-24 Years of Age) Lost to Follow-up from Tuberculosis Treatment in Gaborone, Botswana

Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People

Adolescents and young adults (AYA, ages 10-24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.

Spatial distribution and risk factors of adverse treatment outcomes of tuberculosis in Guizhou, China, 2013-2018

The incidence of Tuberculosis (TB) in Guizhou province has ranked to be the top four among the 31 China provinces. The spatial distribution and influencing factors of adverse outcomes of TB in Guizhou are unclear. In our study, the cases information of TB in Guizhou province from 2013 to 2018 was collected, we analyzed the spatial distribution and clusters of five adverse outcomes of TB with ArcMap10.2 software, used logistics regression analysis to assessed risk factors and used Chi-square analysis to analyze variation trend of the five adverse outcomes. A total of 237, 806 cases information of TB were collected. The proportion of adverse outcomes in TB patients was 6.18%, among which adverse reactions accounted for 1.05%, lost to follow-up accounted for 1.44%, treatment failed accounted for 1.15%, died accounted for 2.31%, switch to MDR accounted for 0.24%. The component ratio of adverse outcomes showed an upward trend (P < 0.05).Regional clustering existed in each of adverse outcomes (P < 0.05). There were high-risk minorities, gender, age, occupation, type of diagnosis, Therapeutic category existed in adverse outcomes of TB. Miao and Dong had a higher risk in adverse reaction of TB compared with Han. Women had a higher risk in adverse reactions than men, and a lower risk of lost to follow-up, failed, and died. Retreated patients had a higher risk of adverse outcomes. Timely monitoring and active intervention should be carried out for some high-risk areas and groups, including middle-aged and elderly patients, rural patients, floating patients, severe patients and retreated patients during the process of patient diagnosis and treatment.

TB and TB-HIV care for adolescents and young adults

SETTING: Nine high-burden public tuberculosis (TB) clinics in Gaborone, Botswana.OBJECTIVE: To evaluate the challenges encountered, healthcare worker (HCW) approaches, and supported interventions in TB and TB-HIV (human immunodeficiency virus) care for adolescents and young adults (AYA, aged 10-24 years).DESIGN: Semi-structured interviews with HCW in TB clinics, analyzed using thematic analysis.RESULTS: Sixteen HCWs were interviewed. AYA developmental needs included reliance on family support for care, increasing autonomy, attending school or work, building trust in HCWs, and intensive TB education and adherence support. Stigma strongly influenced care engagement, including clinic attendance and HIV testing. Health system barriers to optimal AYA TB care included limited staffing and resources to follow-up or support. HCWs utilized intensive education and counseling, and transitioned AYA to community-based directly observed therapy whenever feasible. HCWs supported implementation of youth-friendly services, such as AYA-friendly spaces or clinic days, training in AYA care, use of mobile applications, and peer support interventions, in addition to health system strengthening.CONCLUSION: HCWs utilize dedicated approaches for AYA with TB, but have limited time and resources for optimal care. They identified several strategies likely to improve care and better retain AYAs in TB treatment. Further work is needed to study interventions to improve AYA TB care and outcomes.