The scale-up of antiretroviral therapy coverage was strongly associated with the declining tuberculosis morbidity in Africa during 2000–2018

Boah, Michael; Jin, Baiming; Adampah, Timothy; Wang, W.; Wang, K.

doi:10.1016/j.puhe.2020.04.021

Cited by 2 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A larger study might identify a more obvious pattern. If a true decline exists, it might be associated with the recent scale-up of Anti-Retroviral Therapy (ART) at MRRH as pointed out in a study in African countries [33]. In 2013, in order to increase access to ART and improve clinical outcomes, the Uganda Ministry of Health began recommending that all HIV-infected children under the age of 15 years must be initiated on Highly Active Antiretroviral Therapy (HAART) at the time of diagnosis (15); this would have been expected to lead to a decline in TB cases [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Monje¹,

Kadobera²,

Owolabi³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Childhood tuberculosis (TB) remains a major public health problem in Uganda. Failure to complete TB treatment is associated with development of multi-drug-resistant TB, continued spread of TB, and death. The World Health Organization (WHO) recommends treatment success rates of ≥85% to achieve TB control, but children often have lower success rates due to challenges in case identification and treatment adherence. We assessed trends in childhood TB case notification rates, spatial case distribution, treatment outcomes, and predictors of treatment completion at Mbale Regional Referral Hospital (MRRH) in Eastern Uganda.Methods: We reviewed TB registers and extracted data for patients aged 0-14 years with presumptive TB at MRRH for 2013-2017. We determined the childhood TB case notification rate in the MRRH catchment area, performed a TB case notification rate trend analysis and described spatial TB case distribution. We used logistic regression to identify patient-related and hospital-related factors associated with completion of TB treatment at MRRH among HIV-positive and HIV-negative patients. Results: We identified 331 TB case notifications among children <15 years. TB case notification rates declined from 6.6/100,000 in 2013 to 2.2/100,000 in 2017 [odds ratio (OR)=0.81; 95% confidence intervals (CI)=0.58-1.1]. Mbale District recorded the highest TB case notification rate (79/100,000), and Kapchorwa District recorded the lowest TB case notification rate (3.8/100,000). Completion rates varied from 35% to 80%. Of the 331 patients, 167 (50%) completed TB treatment. In logistic regression, 142 (75%) of 189 HIV-negative TB patients completed TB treatment compared to 25 (54%) of 46 HIV-positive TB patients (OR=2.5; 95%CI=1.3-4.9). Seventy-four (63%) of 117 patients in the facility-based model and 93 (79%) of patients in the community-based model completed TB treatment (OR=0.47; 95% CI=0.26-0.83).Conclusions: Only half of childhood TB patients completed treatment, well below the WHO target of ≥85% completion. Although TB completion was associated with treatment model and HIV-negative status, neither HIV-positive nor HIV-negative patients had acceptable completion rates. MRRH should strengthen HIV treatment services among childhood TB patients by engaging peer groups and trusted community leaders to provide education on the importance of completing TB treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Monje¹,

Kadobera²,

Owolabi³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Several routine programmes have observed decreases in TB notification rates/diagnoses coincident with routine ART scale-up over time [4][5][6][7][8][9][10][11][12][13][14][15]. Three further observational studies using different study designs and outcomes, found an association between increasing ART coverage under routine programmatic conditions and decreases in population-level measures of TB [16][17][18]. While it is plausible that ART use may in part explain these observations, it is not possible to conclude based on these observational findings alone, that ART can control TB in sub-Saharan Africa.…”

Section: Introductionmentioning

confidence: 99%

Incidence of self-reported tuberculosis treatment with community-wide universal testing and treatment for HIV and tuberculosis screening in Zambia and South Africa: A planned analysis of the HPTN 071 (PopART) cluster-randomised trial

Telisinghe,

Floyd,

MacLeod

et al. 2024

PLoS Med

View full text Add to dashboard Cite

Background HIV is a potent risk factor for tuberculosis (TB). Therefore, community-wide universal testing and treatment for HIV (UTT) could contribute to TB control, but evidence for this is limited. Community-wide TB screening can decrease population-level TB prevalence. Combining UTT with TB screening could therefore significantly impact TB control in sub-Saharan Africa, but to our knowledge there is no evidence for this combined approach. Methods and findings HPTN 071 (PopART) was a community-randomised trial conducted between November 2013 to July 2018; 21 Zambian and South African communities (with a total population of approximately 1 million individuals) were randomised to arms A (community-wide UTT and TB screening), B (community-wide universal HIV testing with treatment following national guidelines and TB screening), or C (standard-of-care). In a cohort of randomly selected adults (18 to 44 years) enrolled between 2013 and 2015 from all 21 communities (total size 38,474; 27,139 [71%] female; 8,004 [21%] HIV positive) and followed-up annually for 36 months to measure the population-level impact of the interventions, data on self-reported TB treatment in the previous 12 months (self-reported TB) were collected by trained research assistants and recorded using a structured questionnaire at each study visit. In this prespecified analysis of the trial, self-reported TB incidence rates were measured by calendar year between 2014 and 2017/2018. A p-value ≤0.05 on hypothesis testing was defined as reaching statistical significance. Between January 2014 and July 2018, 38,287 individuals were followed-up: 494 self-reported TB during 104,877 person-years. Overall incidence rates were similar across all arms in 2014 and 2015 (0.33 to 0.46/100 person-years). In 2016 incidence rates were lower in arm A compared to C overall (adjusted rate ratio [aRR] 0.48 [95% confidence interval (95% CI) 0.28 to 0.81; p = 0.01]), with statistical significance reached. In 2017/2018, while incidence rates were lower in arm A compared to C, statistical significance was not reached (aRR 0.58 [95% CI 0.27 to 1.22; p = 0.13]). Among people living with HIV (PLHIV) incidence rates were lower in arm A compared to C in 2016 (RR 0.56 [95% CI 0.29 to 1.08; p = 0.08]) and 2017/2018 (RR 0.50 [95% CI 0.26 to 0.95; p = 0.04]); statistical significance was only reached in 2017/2018. Incidence rates in arms B and C were similar, overall and among PLHIV. Among HIV–negative individuals, there were too few events for cross-arm comparisons. Study limitations include the use of self-report which may have been subject to under-reporting, limited covariate adjustment due to the small number of events, and high losses to follow-up over time. Conclusions In this study, community-wide UTT and TB screening resulted in substantially lower TB incidence among PLHIV at population-level, compared to standard-of-care, with statistical significance reached in the final study year. There was also some evidence this translated to a decrease in self-reported TB incidence overall in the population. Reduction in arm A but not B suggests UTT drove the observed effect. Our data support the role of UTT in TB control, in addition to HIV control, in high TB/HIV burden settings. Trial registration ClinicalTrials.gov: NCT01900977.

show abstract

The scale-up of antiretroviral therapy coverage was strongly associated with the declining tuberculosis morbidity in Africa during 2000–2018

Cited by 2 publications

References 24 publications

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Incidence of self-reported tuberculosis treatment with community-wide universal testing and treatment for HIV and tuberculosis screening in Zambia and South Africa: A planned analysis of the HPTN 071 (PopART) cluster-randomised trial

Contact Info

Product

Resources

About