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

机译:老年结核病控制与预防的战略框架:对结束TB目标的影响综述

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摘要

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.
机译:摘要随着人口衰老的快速速度,老年人的结核病(TB)越来越成为公共卫生挑战。尽管老年人的TB负担越来越高,但目标战略尚未得到很好的理解和评估。我们开展了一个裁剪审查,以确定老年人的当前结核病战略,研究和政策差距,并在战略框架内逐步朝向最终结核病目标。在1990年1月至2015年1月至2015年12月在英语之间进行了Embase,Medline,Global Health和EBM评论的数据库。根据公共卫生角度,在老年人审查了TB战略,方案,指导或干预的文章包括在内。 19篇文章符合纳入标准。其中大多数是在高中和中等收入国家和2000年之后发布的定性研究。为了破坏老年人的结核病传播和重新激活,感染控制,避免诊断和遏制的干预措施对于预防传播至关重要,特别是在老年机构和老年人移民;潜伏TB感染和预防治疗的筛选对降低重新激活风险有效的影响,并且应该在老年人中不情愿地使用;利用高度征集优化索引优化,系统筛查,优先考虑的高风险群体,初始经验和充分的后续治疗,密切监测和评估,以及增强的程序管理是有源结核病消除的基本柱子。评估结核病流行病学,危险因素,影响和成本效益,采用准确和快速的诊断工具,更短,毒性的预防性疗效,对老年人朝向结束TB目标的发展战略是关键问题。老年人的控制策略在因果关系途径中全面映射。本研究中确定的框架和原则将有助于评估和改进当前计划,开发有针对性的策略,以及提高关于研究优先设置和策略转换的更多讨论。鉴于政策和评估干预措施的缺点,以及易于转移Tb流行病学和策略,特别是在发展中国家,对老年人的准备结核计划的需求日益增加进一步研究。

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