Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study

News article 14 Sep 2021

LSTM’s Dr Tom Wingfield has been jointly leading a retrospective cohort study in Brazil looking at the social and health factors that are associated with unfavourable treatment outcomes for young people with tuberculosis (TB).

The results of the study, which are published today in the journal The Lancet Global Health, found that race, poverty, and factors such as homelessness, HIV and illicit drug use were associated with unfavourable outcomes in the age group examined, those aged 10-24 years. Dr Wingfield explained: “To our knowledge this study is the first nationally representative analysis of the characteristics of young people with TB in Brazil. Previously, there was little evidence on the health and social factors that could be associated with unfavourable treatment outcomes in this sometimes underserved group. It is important to understand how these issues can be addressed appropriately so that TB control in Brazil is not hampered. This is particularly important given the negative impact of the COVID-19 pandemic on national TB control programmes everywhere.”

Carrying out a retrospective cohort study using data from Sistema de Informação de Agravos de Notificação (SINAN), the national tuberculosis registry in Brazil and one of the largest in the world, the team - made up of researchers from LSTM, The London School of Hygiene and Tropical Medicine (LSHTM), the WHO Collaborating Centre on Tuberculosis and Social Medicine, Karolinska Institutet, Stockholm, Sweden and the Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil – looked at those aged between 10 and 24 years who were newly diagnosed with TB between January 2015 and December 2018.

Dr Louisa Chenciner of Karolinska Institutet, Sweden, the first author on the paper, comments: “In parallel with COVID-19, we know that young people are more likely to contribute to onward TB transmission, not only because of increased likelihood of infectious pulmonary tuberculosis but also due to their engagement with wider social networks through education, work, family and friends with the highest risk of transmission between 12 and 24 years of age. Almost one fifth of all TB cases registered over the study time frame were young people. Given an upward trend in TB cases in Brazil, contributing to new cases of TB increasing across the Americas, it is crucial that this age group is not overlooked in wider, national TB programmes.”

Over 40,000 young people were included in the study and the team defined unfavourable outcomes as loss to follow-up, treatment failure, and death, while favourable outcomes was defined as treatment success. Multiple logistic regression models were used to estimate the association between social and health factors and TB treatment outcomes. In total 17% of participants had unfavourable treatment outcomes, with homelessness, HIV and illicit drug use the main factors associated with unfavourable results. Young people who received government cash transfers, some as part of the Bolsa Familia Programme, were less likely to have an unfavourable outcome

Dr Julia Pescarini of LSHTM is co-senior author on the paper. She said: “Although TB treatment is free and we have SUS (Sistema Universal de Saúde – a Universal Healthcare System), we have to improve strategies so adolescents and young adults can adhere to TB treatment. TB is still a stigmatizing disease and we see that the most disadvantaged adolescents and young adults might not have the coping mechanisms they need to thrive in society”.

This study contributes to a growing evidence base that young people with tuberculosis need greater attention in national tuberculosis control programmes, which is particularly relevant for policy makers, health-care providers, and civil society representatives. The findings emphasise the need for individualised, patient-centred tuberculosis care for young people, and indicate the potential for targeted social support and protection strategies to increase treatment success of young people with tuberculosis.

Louisa Chenciner, MSc Kristi Sidney Annerstedt, PhD Julia M Pescarini, PhD Tom Wingfield, PhD 
Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study -
The Lancet Global Health  Vol 9, issue 10, E1380-E1390, October, 2021  DOI: