Adolescents and young adults with TB in a low-incidence setting

TL;DR

This study examines TB in adolescents and young adults in a high-income, low-TB setting, finding delays in healthcare presentation and common social risk factors.

Contribution

The study provides insights into TB management outcomes among AYA in a low-incidence setting, highlighting the role of social risk factors.

Findings

AYA with TB experienced a median delay of 45 days from symptom onset to healthcare presentation.

25.3% of patients had cavitary disease, and 32.3% had social risk factors.

Patients with social risk factors were more likely to receive observed therapy.

Abstract

Adolescents and young adults (AYA) with TB have distinct physical and social characteristics compared to other age groups. This study describes a cohort of AYA with TB in a low TB-prevalence, high-income setting and investigates whether demographic or social factors affect management outcomes.

A retrospective cohort study was conducted at a TB referral centre in North West London, including patients aged 10–24 years from 2015 to 2022. Median days from symptom onset to healthcare presentation were determined and risk factors for late presentation (>60 days) were assessed.

Among 158 patients (median age 20 years, IQR 17–23), 53.6% had pulmonary TB, 39.9% extrapulmonary disease, and 5.7% disseminated disease; 25.3% had cavities. Social risk factors were present in 32.3% of patients. Median delay to presentation was 45 days (IQR 14–96), with 38.7% presenting after two months. Delays were longer in patients with incarceration, drug misuse, or mental health issues, though not statistically significant. Patients with social risk factors were more likely to receive observed therapy (OR 2.65, IQR 1.27–5.64).

AYA with TB in this setting experienced delays in healthcare presentation and a quarter had cavitary disease. Social risk factors were common but not significantly related to outcomes.

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