Abstract
Tuberculosis elimination strategies in Brazil might neglect adolescents and young adults aged 10-24 years, hampering tuberculosis control. However, little is known about factors associated with tuberculosis treatment outcomes in this underserved group. In this study, we aimed to investigate social and health factors associated with unfavourable treatment outcomes in young people with tuberculosis in Brazil. A national retrospective cohort study was done using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil. People aged 10-24 years (young people) with tuberculosis registered in SINAN between Jan 1, 2015, and Dec 31, 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, and death. Favourable outcome was defined as treatment success. Multiple logistic regression models estimated the association between social and health factors and tuberculosis treatment outcomes. 67 360 young people with tuberculosis were notified to SINAN, and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes. Young people who received government cash transfers were less likely to have an unfavourable outcome (adjusted odds ratio 0·83, 95% CI 0·70-0·99). Homelessness (3·03, 2·07-4·42), HIV (2·89, 2·45-3·40), and illicit drug use (2·22, 1·93-2·55) were the main factors associated with unfavourable treatment outcome. In this national cohort of young people with tuberculosis in Brazil, tuberculosis treatment success rates were lower than WHO End TB Strategy targets, with almost a fifth of participants experiencing unfavourable treatment outcomes. Homelessness, HIV, and illicit drug use were the main factors associated with unfavourable outcome. In Brazil, strategies are required to support this underserved group to ensure favourable tuberculosis treatment outcomes. Wellcome Trust, UK Medical Research Council, and UK Foreign Commonwealth and Development Office.
Highlights
Tuberculosis is a disease of poverty, which dispro portionately affects individuals who are socially and economically vulnerable.[1,2,3] Before the COVID-19 pandemic, tuberculosis was the leading cause of death from a single infectious agent globally.[4]
67 360 young people with tuberculosis were notified to Sistema de Informação de Agravos de Notificação (SINAN), and we included 41 870 young people in our study. 7024 (17%) of the 41 870 included individuals had unfavourable treatment outcomes
Between Jan 1, 2015, and Dec 31, 2018, 67 360 young people with tuberculosis were notified to SINAN. 41 870 young people were included in the final study population, with 25 490 (38%) of notifications excluded using the study exclusion criteria
Summary
Tuberculosis is a disease of poverty, which dispro portionately affects individuals who are socially and economically vulnerable.[1,2,3] Before the COVID-19 pandemic, tuberculosis was the leading cause of death from a single infectious agent globally.[4]. Before the COVID-19 pandemic, WHO estimated that less than 70% of all new tuberculosis cases were notified to surveillance systems and this proportion was likely to be even lower among young people aged 10–24 years (hereafter referred to as young people; appendix p 1).[4,6] In 2018, the global burden of tuberculosis for young people was calculated for the first time. An estimated 1·8 million young people developed tuberculosis disease in 2018, comprising 17% of all new tuberculosis cases worldwide.[6] Compared with children, young people are at increased risk of tuberculosis infection, tuberculosis disease, and tuberculosis-related complications.[7,8]
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