Youth-friendly health services for tuberculosis care: an integrative review and implementation science synthesis

Adolescents and young adults (AYAs) face disproportionate risk of tuberculosis (TB) due to biological vulnerability, mobility, distinct risks for HIV infection and treatment failure, structural barriers, and limited access to adolescent-responsive care. Although the World Health Organization recommends youth-friendly health services (YFHS), implementation in TB care has received little attention. This review synthesizes current evidence on the application of YFHS principles across the TB care continuum to inform models responsive to the needs of AYAs.

An integrative review was conducted using established methodology and included qualitative, quantitative, and conceptual studies of YFHS in TB care for individuals aged 10 to 24 years in high- and medium-burden countries. Searches were performed in four scientific databases. Two reviewers independently screened records, extracted data, and conducted quality appraisal using Joanna Briggs Institute tools. A deductive thematic synthesis was applied based on the five YFHS domains: for accessible, acceptable, equitable, appropriate, and effective care. Implementation gaps were examined using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.

Of 6,067 records screened, 16 studies met inclusion criteria. Most focused on TB treatment, with limited attention to prevention or diagnosis. Strategies to improve accessibility included decentralized services, mobile health tools, and community-based models. Acceptability was related to respectful provider communication, youth-oriented spaces, and privacy protections to reduce stigma. Gaps in equitable care included restrictive consent laws and the absence of tailored services for vulnerable youth. Appropriateness emphasized the importance of integrated care and confidentiality, while effectiveness depended on staff training, clinical readiness, and prompt treatment initiation. Persistent implementation barriers included misaligned policies, fragmented service structures, and limited involvement of youth in service design.

There is an urgent need for adolescent-responsive TB strategies that align service delivery with the preferences and realities of AYAs. Standardized YFHS indicators, meaningful youth engagement, and context-sensitive facilitation approaches are critical to guide implementation. Integrating YFHS principles into national TB programs—supported by dedicated facilitators, cross-sectoral collaboration, and strengthened health systems—has the potential to improve care engagement and outcomes for AYAs living with or at risk of TB.