Response to anti-tuberculosis treatment by people over age 60 in Kampala, Uganda

Abstract

While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014–2015. We analyzed the 2014–15 cohort with respect to age, sex, disease class, patients’ human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young (AOR 0.39; 95% CI 0.33–0.48, p<0.001), they had a two-fold higher risk of unfavorable treatment outcomes (AOR 2.14; CI 1.84–2.72, p<0.001) and were more likely to die while on treatment (AOR 1.86; CI 1.27–2.73; p = 0.001). However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.

Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India

“…The proportion of elderly TB observed in our study (14.9%) is similar to that observed in previous studies conducted in India such as Karnataka (18.7%) [33], Tamil Nadu (14%) [34] and Punjab (12.3%) [35] and other countries such as Nigeria [36], Uganda [8], Taiwan [9] and United States [10]. However, this might be expected to increase over time given the increasing life expectancy in India.…”

“…The increased notification of TB in older persons (aged 65 years and above) in 2016 globally confirms this [7]. Many countries are now reporting a disproportionate increase in elderly TB compared to the rise in the elderly population [8][9][10]. Age and nutrition-related factors have also been shown to negatively impact treatment outcomes among elderly TB [11][12][13].…”

Treatment success rate and associated factors among drug susceptible tuberculosis individuals in St. Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study

“…This is comparable to what has been reported in other studies such as that by, Izudi et al, who reported that successful treatment of TB was less likely to occur among patients older than 50 years [ 12 ]. Similarly, Sebuliba et al found that older individuals (aged 65+ years) had two-fold increased odds of poor TB treatment outcomes, compared to younger individuals, in a Kampala cohort [ 28 ]. Older individuals are more likely to have co-morbidities such as hypertension that increase chances of poor TB treatment outcomes [ 29 ].…”

Tuberculosis treatment success rate, associated factors and outcomes in St.Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study.

“…For instance, Izudi et al, reported that successful treatment of TB was less likely to occur among patients older than 50 years [20]. Similarly, Kirirabwa et al found that older individuals (aged 65 + years) had two-fold increased odds of poor TB treatment outcomes, compared to younger individuals, in a Kampala cohort [21]. Older individuals are more likely to have co-morbidities such as hypertension and endocrine abnormalities that increase chances of poor TB treatment outcomes.…”