6336 Adolescents and young adults with tuberculosis in Northwest London: a retrospective cohort study

<h3>Objectives</h3> To describe the population of adolescents and young adults affected by tuberculosis in Northwest London, and evaluate the delivery of tuberculosis care in this cohort. <h3>Methods</h3> Electronic records of patients aged 10–24 years with tuberculosis disease (TBD) or infection (TBI) seen at Imperial College Healthcare NHS Trust between 01/01/2018 and 01/10/2022 were analysed. Denominators for each data category represent the number of patients where relevant details were available. Data was analysed using descriptive statistics (table 1). <h3>Results</h3> A total of 134 patients (86 tuberculosis disease (TBD) and 48 tuberculosis infection (TBI)) were identified. For those with TBD, 41/85 (48%) had pulmonary disease, 2/85 (2%) disseminated and 1/85 (1%) miliary TB; cavities were present in 16/85 (19%) of patients with pulmonary disease. Culture confirmation was obtained in 57/83 (69%). Sensitivities showed 48/53 (91%) fully sensitive, 7/53 (13%) single-drug resistance and 3/52 (5.7%) multi-drug resistant cases. A&amp;E was the commonest setting of initial presentation (39/86; 44%), followed by general practice (16/86, 18%). Median delay between symptom onset and treatment was 75 days (IQR 35–179). The median delay between TB referral and presentation to TB services was 1 day (IQR 0–6), with 69/86 (80%) treated on the same or next day following diagnosis. No concerns with adherence to treatment were reported for most patients with TBI or LTB (109/131; 83%). All patients with TBD received an HIV test, compared to 26/48 (54%) of those with TBI. Directly observed therapy was offered to 35/77 (45%) patients with TBD; 28/35 (80%) accepted it. A total of 33/85 (39%) TBD and 13/48 (27%) TBI patients had at least one psychosocial risk factor. The most common in patients with TBD were homelessness (20/85; 23%), asylum-seeking status (19/85; 22%), smoking (16/85; 19%), mental health issues (14/85; 16%). For TBI homelessness (10/48; 21%) and asylum-seeking status (10/48; 21%) were the most common. <h3>Conclusion</h3> Adolescents and young adults treated for tuberculosis in Northwest London are vulnerable, as evidenced by their high rate of psychosocial risk factors. Delays between symptom onset and treatment stem from delayed presentation to healthcare. This population would benefit from dedicated tuberculosis services tailored to their needs, with focus on reducing barriers to care and improving access to treatment.