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Table 2 Summary of strategic framework of TB control and prevention in the elderly: identified in 19 selected articles

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

 

Strategy

Affecting factors/Strategic concerns

Suggestions/recommendations

Preventing transmission

Infection control measures [6, 13, 19–26]

 • Administrative actions

 • Engineering and environmental controls

 • Personal protective measures

Maintaining good ventilation and avoiding overcrowding in public [6, 13, 19, 21, 23–25, 27]

Longer delay in diagnosis and treatment [6, 13, 19, 20, 22, 24, 26–28],

Residents and healthcare worker in elderly institution [6, 13, 19–24, 26–28]

Immigration from a high-prevalence country [13, 19, 24, 26, 28, 29]

Early diagnosis and containment [13, 19–21, 24]

Evaluation of infection control measures for TB suspects and patients [21, 25, 26]

 • Stay in infection isolation rooms or single rooms wearing surgical masks

 • Transferred to a facility with appropriate isolation capacity

Early detection

Optimizing case-finding along patient-initiated pathway [15, 19, 25, 29–32]

 • Increasing patient access to care

 • Using new diagnostics

 • Streamlining the diagnostic pathway

Systematic screening pathway in high risk groups

 • Screen of LTBI [6, 13, 15, 19–32]

 • Active case-finding of TB patients [15, 20, 21, 27, 29–31, 33]

 • Diagnostics and screening algorithms: TST [6, 13, 19–28, 30, 32] or IGRA [6, 26–28, 31]; CXR and bacteriological examination [15, 20, 21, 27, 29–31, 33].

High risk factors [6, 22, 23, 26, 27]

 • Ageing itself, male predominance, smoking, malnutrition, and BMI < 18.5

Comorbidities [6, 13, 19, 20, 22–24, 27, 28, 33]

 • chronic obstructive pulmonary disease, DM, lung cancer, silicosis, malignancy, liver disease, cardiovascular diseases and gastrectomy

Atypical presentation [6, 13, 19, 20, 22–28, 34]

 • Atypical symptom: weight loss, weakness, anorexia, cognitive impairment, and dyspnoea

 • Atypical CXR presentation: lower lobe infiltrate, pleural effusions and extensive disease

Extrapulmonary TB [6, 13, 19, 22–26, 28] and NTM [13, 19, 27, 28, 34]

Economic and impact evaluation [15, 29–33]

Limitation of diagnostic tools for LTBI [6, 13, 19–28, 30, 31]

A high index of suspicion and close contacts [6, 13, 19, 21–24, 26–28]

Systematic screening is recommended in

 • Residents and healthcare workers in elderly institutions on admission and periodically [6, 13, 19–21, 24–26, 28]

 • Regions with high prevalence of infection [6, 13, 19, 22, 23, 27, 28] and TB disease [13, 19–21, 25, 26]

 • Targeted approach on high-risk groups of recent infection or reactivation [6, 13, 19, 28]

 • Integrating health examination [33]

More aggressive diagnostic tools [6, 13, 19, 22, 23, 25, 26]

Rapid diagnostic tools [22, 23, 25, 26, 28]

Appropriate treatment

Preventive treatment of LTBI

 • Isoniazid preventive therapy [6, 13, 15, 19–28, 30, 31]

 • Rifampicin preventive therapy and other alternatives [6, 13, 19, 26, 28]

Treatment of TB

 • The therapy for elderly is not necessarily different [6, 13, 19, 24, 28], but can be compromised [13, 19, 28] or prolonged [26]

 • Empirical initiation of treatment for presumptive TB [13, 19, 26–28]

 • Adequate follow-up treatment[13, 19, 21–23, 26–28]

Hepatotoxicity for preventive therapy [6, 13, 19, 22–28, 30]

Comorbidities [6, 13, 19, 20, 22–24, 27, 28, 33]

Drug interaction and adverse effect [6, 13, 19, 22–24, 26, 27, 34]

Poor drug tolerance [6, 26, 27]

Poor treatment adherence [13, 19, 26, 27]

Unfavourable treatment outcome [6, 13, 19, 27, 28]

No age limit and used less reluctantly for LTBI preventive treatment in elderly [13, 19, 26, 27, 28]

Short, less toxic preventive therapy regimens [6, 15, 30]

Careful pre-treatment assessment and close clinical monitoring for IPT [6, 13, 19–26, 28]

Baseline and periodic laboratory testing for liver function [6, 13, 19, 22, 23, 25, 26, 28]

Closer monitoring and evaluation during follow-up treatment [13, 19–21, 24, 26–28]

 • Evaluation of therapy compliance

 • Investigation of sputum conversion

 • Screening for adverse effects and toxicity

Education [6, 20, 28]

Programmatic management

Responsibility [20, 21, 24, 25, 27]

 • Department of health

 • Primary healthcare provider

Surveillance [21, 25, 27, 29]

Education [19–21, 24, 25]

Assessment [21, 25]

Increasing source of TB reactivation [6, 13, 15, 19, 20, 22–28]

Socioeconomic determinants [6, 19, 24, 27]

 • Poverty, inadequate healthcare, stigma and misconception, malnutrition, unhealthy lifestyle

Awareness of changing epidemic and impact of the elderly towards End TB targets [6, 13, 15, 19, 26, 27, 29]

Interventions aimed at reducing TB reactivation [6, 15, 30]

Maintaining high-quality programme [30]

Actions for improving socioeconomic status [6, 19, 24, 27]