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

<sec><title>BACKGROUND</title>Non-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.</sec><sec><title>METHODS</title>We 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.</sec><sec><title>RESULTS</title>Adolescents 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).</sec><sec><title>CONCLUSION</title>Adolescents 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.</sec>.