Comparison of Trends in Tuberculosis Incidence among Adults Living with HIV and Adults without HIV – Kenya, 1998–2012

Abstract

BackgroundIn Kenya, the comparative incidences of tuberculosis among persons with and without HIV have not been described, and the differential impact of public health interventions on tuberculosis incidence in the two groups is unknown.MethodsWe estimated annual tuberculosis incidence stratified by HIV status during 2006–2012 based on the numbers of reported tuberculosis patients with and without HIV infection, the prevalence of HIV infection in the general population, and the total population. We also made crude estimates of annual tuberculosis incidence stratified by HIV status during 1998–2012 by assuming a constant ratio of HIV prevalence among tuberculosis patients compared to the general population.ResultsTuberculosis incidence among both adults with HIV and adults without HIV increased during 1998–2004 then remained relatively stable until 2007. During 2007–2012, tuberculosis incidence declined by 28–44% among adults with HIV and by 11–26% among adults without HIV, concurrent with an increase in antiretroviral therapy uptake. In 2012, tuberculosis incidence among adults with HIV (1,839–1,936 cases/100,000 population) was still eight times as high as among adults without HIV (231–238 cases/100,000 population), and approximately one third of tuberculosis cases were attributable to HIV.ConclusionsAlthough tuberculosis incidence has declined among adults with and without HIV, the persistent high incidence of tuberculosis among those with HIV and the disparity between the two groups are concerning. Early diagnosis of HIV, early initiation of antiretroviral therapy, regular screening for tuberculosis, and isoniazid preventive therapy among persons with HIV, as well as tuberculosis control in the general population, are required to address these issues.

High tuberculosis burden among people living with HIV in southern Mozambique

“…These figures, which depend to a great extent on the country TB prevalence and ARV coverage, are in line with those found in African high-burden countries [6,8,13], although some of these studies included active case finding, high-risk populations (e.g. miners) or different age groups.…”

“…To our knowledge, this study is the first study in Mozambique providing estimates of TB incidence among the HIV-infected population and one of the few studies assessing TB incidence among PLHIV in a general population in sub-Saharan Africa [8]. The high TB morbidity and mortality associated with HIV infection found in this analysis underscore the urgent need for improved and integrated control efforts for both diseases [12].…”

Scale-up of ART in Malawi has reduced case notification rates in HIV-positive and HIV-negative tuberculosis

“…Similar findings have recently been reported from a 15-year observational study in Kenya, where there was a 28-44% decrease in HIV-positive TB and an 11-26% decrease in HIV-negative TB. 21 The strengths of this study are the comprehensive national reports, which for TB have integrated HIV parameters since 2005, and the recognised quality of Malawi's ART data. 22 The limitations relate mainly to the aggregate nature of the data, which rely on accurate TB case notifications from Malawi's many TB registration centres, and which prevent detailed examination and explanation of some of the observations, such as time of ART initiation in HIV-infected TB patients.…”

Tuberculosis data sampling of a district hospital in Malawi: An epidemiological perspective

“…Both Kenya and Malawi have reported decreases in tuberculosis incidence among both HIVinfected and uninfected people (Yuen et al, 2014;Kanyerere et al, 2014). WHO established a global TB monitoring system and accordingly, 20 annual rounds of data collection have been completed.…”