OpiniãoAdolescents are at risk of TB infection, progression to TB disease, and loss to follow-up from TB care. Adolescents with MDR-TB or with TB/HIV coinfection are at particular risk of poor treatment outcomes, including death. Adherence, stigma, mental health and quality of life are impacted negatively by adverse effects of TB treatment, especially second-line treatment. Substance or alcohol use may have an impact on adverse events and TB care outcomes, although their prevalence among adolescents with TB is not known, and strategies for recognizing and managing substance or alcohol use have not been defined. Data on TB risk and outcomes for pregnant adolescents are lacking.
Specific factors related to adolescent development and vulnerabilities impact engagement of adolescents in TB prevention and treatment. Although recommended as a target group for TPT by WHO (28), adolescents are often not prioritized for TPT provision, and data on TPT uptake and completion for adolescents are seldom reported. Lower adherence to TPT has been associated with stigma, costs or challenges associated with clinic visits, and presence of risk behaviours (210, 211).
Challenges related to diagnosis or treatment for adolescents with TB are highlighted in a limited number of studies, including:
- delayed or missed diagnosis of TB in adolescents (212, 213);
- increased risk for poor adherence to TB treatment, including loss to follow-up (214–219).
Many factors that affect adolescent engagement with TB treatment have been described, including family challenges, poverty, stigma, attending work or school, and migration. Treatment fatigue and adverse effects have a negative impact on treatment adherence, particularly among adolescents with MDR/RR-TB or with TB/HIV coinfection. Adolescents often disengage from TB treatment during the continuation phase of treatment when their symptoms improve and treatment frequency decreases. Facility-based directly observed therapy is often inaccessible or unacceptable for adolescents, due to anticipated stigma, concerns about confidentiality, travel costs, and need to attend school or work. Supportive relationships with family members, caregivers and health care providers promote treatment adherence (220).