TRACK TB

While old age is a known risk factor for developing active tuberculosis (TB), studies on TB in the population aged 60 years and older (considered elderly in this study) are few, especially in the developing world. Results of the TB prevalence survey in Uganda found high TB prevalence (570/100,000) in people over 65. We focused on treatment outcomes in the elderly to understand this epidemic better. We conducted a retrospective analysis of data from TB facility registers in Kampala City for the period 2014-2015. We analyzed the 2014-15 cohort with respect to age, sex, disease class, patients' human immunodeficiency virus (HIV) and directly observed therapy (DOT) status, type of facility, and treatment outcomes and compared findings in the elderly (≥60) and younger (<60) age groups. Of 15,429 records, 3.3% (514/15+,429) were for elderly patients. The treatment success rate (TSR) among elderly TB patients (68.3%) was lower than that of the non-elderly (80.9%) and the overall TSR 80.5%, (12,417/15,429) in Kampala. Although the elderly were less likely to test positive for HIV than the young, they had a two-fold higher risk of unfavorable treatment outcomes and were more likely to die while on treatment. However, there was no statistically significantly difference between treatment outcomes among HIV-positive and HIV-negative elderly TB patients. Compared to the younger TB patients, elderly TB patients have markedly poorer treatment outcomes, although TB/HIV co-infection rates in this age group are lower.

A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala District registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done. Of the 10,404 records, 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194. The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597 (43%) to 890 (40.6%) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015. The treatment success rate for PBC TB patients improved from 69% in 2012 to 75.5% by the end of 2015 with an improvement in the cure rate from 52.3% to 62%. There was a significant decrease in TB related mortality from 8.9 to 6.4%. The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. 

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