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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, 1926]
 • Administrative actions
 • Engineering and environmental controls
 • Personal protective measures
Maintaining good ventilation and avoiding overcrowding in public [6, 13, 19, 21, 2325, 27]
Longer delay in diagnosis and treatment [6, 13, 19, 20, 22, 24, 2628],
Residents and healthcare worker in elderly institution [6, 13, 1924, 2628]
Immigration from a high-prevalence country [13, 19, 24, 26, 28, 29]
Early diagnosis and containment [13, 1921, 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, 2932]
 • 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, 1932]
 • Active case-finding of TB patients [15, 20, 21, 27, 2931, 33]
 • Diagnostics and screening algorithms: TST [6, 13, 1928, 30, 32] or IGRA [6, 2628, 31]; CXR and bacteriological examination [15, 20, 21, 27, 2931, 33].
High risk factors [6, 22, 23, 26, 27]
 • Ageing itself, male predominance, smoking, malnutrition, and BMI < 18.5
Comorbidities [6, 13, 19, 20, 2224, 27, 28, 33]
 • chronic obstructive pulmonary disease, DM, lung cancer, silicosis, malignancy, liver disease, cardiovascular diseases and gastrectomy
Atypical presentation [6, 13, 19, 20, 2228, 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, 2226, 28] and NTM [13, 19, 27, 28, 34]
Economic and impact evaluation [15, 2933]
Limitation of diagnostic tools for LTBI [6, 13, 1928, 30, 31]
A high index of suspicion and close contacts [6, 13, 19, 2124, 2628]
Systematic screening is recommended in
 • Residents and healthcare workers in elderly institutions on admission and periodically [6, 13, 1921, 2426, 28]
 • Regions with high prevalence of infection [6, 13, 19, 22, 23, 27, 28] and TB disease [13, 1921, 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, 1928, 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, 2628]
 • Adequate follow-up treatment[13, 19, 2123, 2628]
Hepatotoxicity for preventive therapy [6, 13, 19, 2228, 30]
Comorbidities [6, 13, 19, 20, 2224, 27, 28, 33]
Drug interaction and adverse effect [6, 13, 19, 2224, 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, 1926, 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, 1921, 24, 2628]
 • 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 [1921, 24, 25]
Assessment [21, 25]
Increasing source of TB reactivation [6, 13, 15, 19, 20, 2228]
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]