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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]