Psychosocial experiences of adolescents with tuberculosis in Cape Town.

Adolescents (10-19-years-old) account for almost 10% of the annual global tuberculosis (TB) incidence. Adolescents' experiences of TB care, TB stigma, and the consequences of TB for their relationships, schooling, and mental health are different, and often more severe, compared to younger children and adults. How TB impacts the lives of adolescents is not well described or understood. We aimed to locate adolescents' experiences of TB relative to their psychosocial contexts, describe the impact of TB on adolescents' wellbeing, and describe how TB and its treatment affects their socio-familial contexts. Teen TB was a prospective observational cohort study which recruited 50 adolescents with newly diagnosed TB disease (including both multidrug-resistant TB and drug-susceptible TB) in Cape Town, South Africa. A nested sub-sample of 20 adolescents were purposively sampled for longitudinal qualitative data collection. Nineteen participants completed all qualitative data collection activities between December 2020 and September 2021. Adolescents described their communities as undesirable places to live-rife with violence, poverty, and unemployment. The negative experiences of living in these conditions were exacerbated by TB episodes among adolescents or within their households. TB and its treatment disrupted adolescents' socio-familial connections; many participants described losing friendships and attachment to family members as people reacted negatively to their TB diagnosis. TB, inclusive of the experience of disease, diagnosis and treatment also negatively impacted adolescents' mental health. Participants reported feeling depressed, despondent, and at times suicidal. TB also disrupted adolescents' schooling and employment opportunities as adolescents were absent from school and college for substantial periods of time. Our findings confirm that adolescents' psychosocial experiences of TB are often highly negative, compounding underlying vulnerability. Future research should prioritize exploring the potential of social protection programmes providing adolescents and their families with psychosocial and economic support.