Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

Wellcome Trust, UK Medical Research Council, and UK Foreign Commonwealth and Development Office.

中文翻译：

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与巴西青少年和年轻人结核病不良治疗结果相关的社会和健康因素：一项全国回顾性队列研究

背景

巴西的结核病消除战略可能会忽视 10-24 岁的青少年和年轻人，从而阻碍结核病的控制。然而，对于这个服务不足的群体中与结核病治疗结果相关的因素知之甚少。在这项研究中，我们旨在调查与巴西青年结核病患者不良治疗结果相关的社会和健康因素。

方法

使用来自巴西国家结核病登记系统 Sistema de Informação de Agravos de Notificação (SINAN) 的数据完成了一项全国回顾性队列研究。2015 年 1 月 1 日至 2018 年 12 月 31 日期间在 SINAN 登记的 10-24 岁（年轻人）结核病患者被纳入。不良结局定义为失访、治疗失败和死亡。良好的结果被定义为治疗成功。多元逻辑回归模型估计了社会和健康因素与结核病治疗结果之间的关联。

发现

67 360 名患有结核病的年轻人被告知 SINAN，我们在研究中纳入了 41 870 名年轻人。纳入的 41 870 人中有 7 024 人 (17%) 的治疗结果不佳。接受政府现金转移支付的年轻人出现不利结果的可能性较小（调整后的比值比 0·83，95% CI 0·70–0·99）。无家可归（3·03、2·07–4·42）、艾滋病毒（2·89、2·45–3·40）和非法药物使用（2·22、1·93–2·55）是主要的与不良治疗结果相关的因素。

解释

在巴西这个全国青年结核病队列中，结核病治疗的成功率低于世卫组织终结结核病战略的目标，近五分之一的参与者经历了不利的治疗结果。无家可归、艾滋病毒和非法吸毒是与不利结果相关的主要因素。在巴西，需要制定战略来支持这一服务不足的群体，以确保获得良好的结核病治疗结果。

资金

Wellcome Trust、英国医学研究委员会和英国对外联邦与发展办公室。