Factors associated with unsuccessful TB treatment outcomes in children and adolescents in Indonesia, 2018–2023

Vollständiger Abstract

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BACKGROUNDNon-adherence to TB treatment is associated with substantially increased mortality risk among children, yet determinants of unsuccessful treatment outcomes remain under-recognised. We examined factors associated with unsuccessful TB treatment outcomes among children and adolescents in Indonesia from 2018 to 2023.METHODSWe conducted a retrospective cohort study using the National TB Registry, including 509,290 patients aged 0–19 years with evaluated treatment outcomes. Outcomes were classified as successful (cured or treatment completed) or unsuccessful (death, loss to follow-up, or treatment failure). Multivariable logistic regression was used to identify factors associated with unsuccessful outcomes.RESULTSAdolescents aged 10–19 years had higher odds of unsuccessful treatment compared with children aged 0–4 years (adjusted odds ratio [AOR]: 1.25, 95% confidence interval [CI]: 1.21–1.28). The strongest predictors of unsuccessful outcomes were drug-resistant TB (AOR: 21.90, CI: 8.58–60.10), HIV co-infection (AOR: 3.70, CI: 3.35–4.08), and retreatment status (AOR: 1.98, CI: 1.83–2.14). Marked geographic disparities were observed, with significantly higher odds in Eastern Indonesia (AOR: 2.80, CI: 2.71–2.91).CONCLUSIONAdolescents and children with drug-resistant TB and HIV co-infection, or those receiving retreatment, face markedly increased risks of unsuccessful outcomes, alongside substantial geographic inequities. Strengthened adherence support and regionally targeted interventions are urgently needed.