7.4.7. Poor adherence

Adolescents on treatment for TB disease are at risk for poor adherence in terms of missed doses and loss to follow-up. Predictors of poor treatment adherence for drug-susceptible TB include TB/HIV coinfection, age 15–19 years, prior TB treatment and male gender. For TPT, shorter regimens (e.g. 3HP or 4R) generally have higher completion rates than 6–9 months of isoniazid (see web annex 4). Qualitative studies have highlighted the importance of family support for adherence and identified why some adolescents lack support, including lack of caregiver understanding about TB, severe poverty, family conflict or neglect, and older adolescents moving away from home. Stigma is an important factor affecting adherence in adolescents. Adolescents are reported to be at particularly high risk of poor adherence during the continuation phase, when they are feeling better and the pill burden decreases (see web annex 4).

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