Navigating the Tuberculosis Care Journey: Experiences of Diagnosis, Treatment Discontinuation, and Re-Engagement among Adolescents and Young Adults in Nairobi, Kenya – A Qualitative Study

Background In 2023, approximately 1.6 million adolescents and young adults aged 15–24 developed TB globally. In Kenya, TB care remains largely adult-centric, with limited youth-responsive services. In 2023, approximately 5% of the people initiated on care were lost to follow-up. The reasons why adolescents and young adults disengage from care are not well understood in Kenya. This study explored the TB care journey among young people and examined the factors that trigger TB treatment discontinuation among adolescents and young adults aged 15 to 24 years in Nairobi, Kenya. Methods This study was conducted between October 2024 and January 2025. We conducted in-depth interviews with young people aged 15–24 years who had initiated TB treatment in 2023 and 2024 but did not complete it. Participants were purposively selected from TB treatment registers at five high TB-burden health facilities in Nairobi, supplemented by snowball sampling. We employed inductive and deductive thematic analysis, guided by the TB care cascade, to explore the TB care journey among young people with TB and examined the reasons that contributed to adolescents and young adults aged 15–24 years not completing their TB treatment in Nairobi, Kenya. Results Young people described delays in TB diagnosis due to being treated for other illnesses, unclear communication during testing, and limited counselling. Receiving a TB diagnosis was emotionally overwhelming, with fear and denial contributing to delayed treatment initiation. Side effects, stigma, financial strain, and social structural and gendered roles drove treatment interruption. Non-medical disruptions, including bereavement, homelessness, and arrest during youth political demonstrations, emerged as key contributors to treatment discontinuation among young men, underscoring the influence of social and structural vulnerabilities on TB care. Women noted domestic burdens and partner conflict. Re-engagement occurred after symptom worsening, supportive outreach, or fear of consequences. Positive relationships with providers, including emotional support and transport assistance, helped sustain or resume care. Conclusion Adolescents and young adults with TB face interconnected gender, psychosocial, and system-level challenges along the continuum of care. Youth-friendly and gender-responsive services, such as peer support, better counselling, and flexible services delivered by compassionate, trained providers, are critical to enhancing retention in TB care.