The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

Abstract

With the rapid pace of population ageing, tuberculosis (TB) in the elderly increasingly becomes a public health challenge. Despite the increasing burden and high risks for TB in the elderly, targeted strategy has not been well understood and evaluated. We undertook a scoping review to identify current TB strategies, research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets. Databases of Embase, MEDLINE, Global health and EBM reviews were searched for original studies, review articles, and policy papers published in English between January 1990 and December 2015. Articles examining TB strategy, program, guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria. Most of them were qualitative studies, issued in high- and middle-income countries and after 2000. To break the chain of TB transmission and reactivation in the elderly, infection control, interventions of avoiding delay in diagnosis and containment are essential for preventing transmission, especially in elderly institutions and aged immigrants; screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people; optimizing early case-finding with a high index of suspicion, systematic screening for prioritized high-risk groups, initial empirical and adequate follow-up treatment with close monitoring and evaluation, as well as enhanced programmatic management are fundamental pillars for active TB elimination. Evaluation of TB epidemiology, risk factors, impacts and cost-effectiveness of interventions, adopting accurate and rapid diagnostic tools, shorter and less toxic preventive therapy, are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway. The framework and principals identified in this study will help to evaluate and improve current program, develop targeted strategy, as well as raise more discussions on the research priority settings and policy transitions. Given the scarceness of policy and evaluated interventions, as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries, the increasing need of a ready TB program for the elderly warrants further research.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0284-4) contains supplementary material, which is available to authorized users.

Tuberculosis among older adults in Zambia: burden and characteristics among a neglected group

“…Together, this suggests that the current emphasis on HIV and TB co-morbidity is not sufficient to address the challenges of this under-diagnosed pool of older HIV-uninfected older adults who may have particular challenges with regard to health access due to poverty, rural living, mobility difficulties [ 32 ] and ageist stigma [ 33 ]. There is currently limited evidence regarding successful interventions for the improvement of diagnosis of TB among older adults in LMICs [ 34 ].…”

“…Relatively high rates of TB among older adults challenge the current TB response and require new data and thinking. Li and colleagues’ recent scoping review [ 34 ] identified a number of causal pathways to improve TB prevention and services among older people. While the review focused on articles from high-income countries [ 34 ], some of the interventions might be relevant in low- and middle-income settings.…”

“…Li and colleagues’ recent scoping review [ 34 ] identified a number of causal pathways to improve TB prevention and services among older people. While the review focused on articles from high-income countries [ 34 ], some of the interventions might be relevant in low- and middle-income settings. Screening of latent TB infection for example reduced the risk of reactivation [ 35 , 36 ] and the review authors promoted active systematic screening for high-risk groups to reduce the delay in diagnosis and containment.…”

Accuracy of the chest x-ray in screening for tuberculosis in Uganda: A cross-sectional study.

“…This may be explained by the increase in respiratory pathology associated with increase in age including pneumonia, chronic obstructive pulmonary disease among others. (22) Therefore, the CXR is not a preferred TB screening test among these individuals.…”

Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs

“…However, no age-related differences were found in the Northern California registry [119]. Thus, the role of ageing as additional risk factors for TB [120] in patients under biological treatment needs to be further investigated.…”