To achieve WHO Post-2015 Targets: Simplified Scoping Review for TB Epidemiology and Programmatic Response in Elderly in Hong Kong
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AbstractBackground
Ageing of population is increasingly becoming a global challenge of tuberculosis (TB) control especially in developed world. In Hong Kong, a developed city with intermediate TB burden, it was found as the main reason for TB stagnant endemic after 1990s. In order to achieve WHO End TB target, we conducted a scoping review to identify the epidemiology of and programmatic response to TB in elderly in Hong Kong, to explore research gaps and insights for policy improvement.

Methods
The scoping review was conducted through government reports, technical guidelines and literature. Articles written in English and published before Dec 31st 2015 were reviewed in major electronic databases, with key words of “tuberculosis”, “aged” (“elderly” or “old people”), and “Hong Kong”. Based on specific inclusion criteria, we investigated TB infection, incidence, case finding, treatment and outcome, risk factors, control strategy, health system and services.

Results
In Hong Kong, elderly was found as an important aspect in TB annual reports and TB manual. A total of 33 articles were included for review analysis. The proportion of elderly among patients was increasing from 15.3% in 1985 to 39.0% in 2004 and then level off. In 2013, they accounted for 75% of all TB deaths. High TB infection rate (43.8%, 68.6% and 46.3%) was found in elderly and they were more likely to develop TB by endogenous reactivation (increased from 46% in 1968 to 70% in 2008). Their prevalence and notification rate remained high with little change and increased with age. The elderly patients were more likely to be male, current and ex-smokers, weighing less (BMI<18.5), having seasonal frequency and geographic distribution, a past history of TB and coexisting medical diseases, longer delay in presentation and commencement of treatment, low drug resistance, adverse effects and unfavorable treatment outcome.

Conclusions
This review demonstrated a high TB burden and specific characteristics in elderly patients in Hong Kong. However, few studies were found in terms of control strategy, health services and care, patient awareness and behavior, treatment adherence and qualitative investigation. Further research is needed to explore and improve the
programmatic response.
Acceptance Date06/05/2016
All Author(s) ListLI Jun, CHUNG Pui Hong, LEUNG Lap Kwan Cyrus, TAM Greta Chun Huen, YEOH Eng Kiong
Name of ConferenceThe 47th Union World Conference on Lung Health
Start Date of Conference26/10/2016
End Date of Conference30/10/2016
Place of ConferenceLiverpool
Country/Region of ConferenceGreat Britain
Year2016
LanguagesEnglish-United States

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