S10 Predictors of unfavourable treatment outcome for adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study

<h3>Introduction and Objectives</h3> Young people are often neglected in tuberculosis elimination efforts. Unlike children, young people are likely to contribute to onward transmission of tuberculosis, further perpetuating the epidemic. Brazil has a high burden of tuberculosis, however there is limited knowledge of tuberculosis treatment outcomes among young people in Brazil. This study sought to investigate how predictors of unfavourable tuberculosis treatment outcome vary between adolescents (10–17 years) and young adults (18–24 years), and the extent to which they are included in treatment support strategies. <h3>Methods</h3> A national retrospective cohort study was conducted using Brazilian tuberculosis registry data to investigate the predictors of unfavourable treatment outcome for young people with tuberculosis. Persons between 10–24 years, with newly diagnosed tuberculosis between January 2015 and December 2018, were included. Unfavourable outcomes were defined as loss to follow-up, treatment failure, change in treatment, death. Favourable outcomes were defined as treatment completion or cure. Factors associated with unfavourable treatment outcome were compared between adolescents and young adults, using complete case and missing indicator multiple logistic regression models. <h3>Results</h3> 41,870 young people were included, 7,024 (17%) experienced unfavourable treatment outcomes. 5,869 (14%) were lost to follow-up; of which 86% were young adults, 72% male, 73% identifying with black or brown skin colour, 67% had low educational attainment and 9% diagnosed with HIV/AIDS. HIV/AIDS (OR_adj4.52;95% CI:2.85–7.17), drug use (OR_adj3.66;95% CI:2.36–5.70), identifying with black skin colour (OR_adj2.07;95% CI:1.44–2.98) or low educational attainment (OR_adj2.06;95% CI:1.64–2.59) were most strongly associated with unfavourable outcome in adolescents, as compared to young adults. Conversely, deprivation of liberty was only protective for young adults (OR_adj0.56;95% CI:0.48–0.66). Adolescents and young adults with tuberculosis had similarly low uptake of treatment supervision (52% vs. 52%; p=0.92), however adolescents were more likely to receive governmental cash transfers compared to young adults (17% vs. 8%; p&lt;0.05). <h3>Conclusions</h3> HIV/AIDS, drug use, race and educational attainment are the strongest independent predictors of unfavourable outcome for both adolescents and young adults with tuberculosis in Brazil. Greater efforts are needed to engage vulnerable young people with tuberculosis in treatment support strategies, including treatment supervision and governmental cash transfers.