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. Author manuscript; available in PMC: 2023 Jun 14.
Published in final edited form as: J Adolesc Health. 2023 Mar;72(3):323–331. doi: 10.1016/j.jadohealth.2022.10.036

Table 1:

Proposed interventions to address needs of adolescents and young adults (AYAs) with or at risk of tuberculosis (TB), Part I

Reforming current practices to improve AYA well-being.

  1. AYAs—defined as individuals 10–24 years of age—have unique healthcare needs, dynamic trajectories in growth and development, and TB-related risks. Therefore, national TB programs (NTPs) should report age-disaggregated data for AYAs aged 10–14, 15–19, and 20–24 years. Ideally, the data should be further disaggregated by sex.

  2. AYAs have high epidemiological risks for TB exposure and biological risks for developing TB disease after infection. They also have a propensity to develop cavitary lung disease, with its potential for high transmissibility of TB to others in the household or community. Thus, AYAs should be included as a priority group for active TB case-finding, contact tracing, treatment of M. tuberculosis infection and TB disease, and TB education.

  3. Facility-based treatment support (historically referred to as directly observed treatment, or DOT) disrupts AYAs’ social relationships, education, and vocational training; creates additional financial burdens and barriers to adherence; and exacerbates anticipated and enacted stigma associated with accessing TB care. Therefore, developmentally-appropriate, family-oriented, community-based models of care should be ensured for AYAs, with delivery of treatment support by community health workers, peer supporters, and/or digital adherence technologies such as video supported treatment. Alternatively, for select AYAs and contexts, treatment support may be delivered by family members or caregivers who are trained and supported by health providers.

  4. AYAs treated for TB across global settings report loss of interpersonal relationships, interruptions to education, and mental health burdens that are exacerbated by prolonged isolation and/or hospitalization for TB treatment. Thus, country-specific approaches should minimize isolation and hospitalization for AYA with TB, with implementation of isolation policies based in evidence for infectiousness (i.e., allowing AYAs to return to school or higher education, vocational training, or work as soon as they are no longer infectious and appropriate support and treatment adherence structures are in place).

  5. AYAs younger than 18 years of age are often excluded from TB research; as a result, they are unable to benefit from new advances in TB therapeutics. AYAs–especially those aged under 18 years–should be prioritized for inclusion in clinical trials and observational studies of treatments for infection and disease caused by drug-susceptible and drug-resistant M. tuberculosis, as well as research on diagnostics and social determinants of disease and outcomes.

  6. AYAs experience substantial barriers to treatment adherence and are at risk for loss to follow-up from TB care, and TB treatment often interferes with their education and psychosocial development. These challenges distinguish them as a group that would benefit substantially from shorter regimens for TB preventive treatment (TPT) and for TB treatment. The shortest possible effective TPT and TB treatment regimens recommended by the WHO should be implemented for adolescents to facilitate adherence and minimize interference with education and other developmental tasks.

  7. Adverse effects of first- or second-line treatment, including consideration of the acceptability to AYAs of a medicine’s potential adverse effects, should be discussed with AYAs and their caregivers prior to starting treatment. For example, the reversible skin discoloration associated with clofazimine can lead to discrimination and negative impacts on social relationships. Sharing clear information with AYAs and caregivers regarding potential adverse effects, including the reversibility of certain effects, may help avert significant distress for AYAs and their families.

  8. Sexual and reproductive health care is important for AYA health and well-being. Rifamycins render hormone-based contraception less effective. TB providers should counsel AYAs on contraception methods and ensure that AYAs have access to effective contraception.

  9. Injectable agents should be avoided for AYAs, unless absolutely needed as part of a salvage regimen. Hearing loss associated with injectable agents is particularly devastating for AYAs. Moreover, facility-based daily administration of injectable agents is time-intensive and interrupts schooling, vocational training, and work.