Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi.

OBJECTIVE To report on the trends in new and recurrent tuberculosis (TB) case notifications in a rural district of Malawi that has embarked on large-scale roll-out of antiretroviral treatment (ART). METHODS Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009. RESULTS There were a total of 10,070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifications in the first years after starting ART (2002-2005) was followed by a highly significant and sustained decline from 259 to 173 TB cases per 100,000 population (χ(2) for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a significant drop, from 20 to 15 cases/100,000 (χ(2) for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases. CONCLUSIONS High ART implementation coverage is associated with a very significant declining trend in new and recurrent TB case notifications at population level.

[1]  N. Ford,et al.  Providing universal access to antiretroviral therapy in Thyolo, Malawi through task shifting and decentralization of HIV/AIDS care , 2010, Tropical medicine & international health : TM & IH.

[2]  R. Atun,et al.  Tuberculosis control is crucial to achieve the MDGs , 2010, The Lancet.

[3]  S. Lawn,et al.  The HIV-associated tuberculosis epidemic—when will we act? , 2010, The Lancet.

[4]  A. Harries,et al.  Mortality Reduction Associated with HIV/AIDS Care and Antiretroviral Treatment in Rural Malawi: Evidence from Registers, Coffin Sales and Funerals , 2010, PloS one.

[5]  S. Lawn,et al.  Antiretroviral Therapy for Control of the HIV-associated Tuberculosis Epidemic in Resource-Limited Settings , 2009, Clinics in chest medicine.

[6]  S. Lawn,et al.  Screening for active tuberculosis among patients accessing antiretroviral therapy in sub-Saharan Africa. , 2009, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[7]  A. Van Deun,et al.  Isoniazid preventive therapy for people living with HIV: public health challenges and implementation issues. , 2009, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[8]  Payam Tabarsi,et al.  Early initiation of antiretroviral therapy results in decreased morbidity and mortality among patients with TB and HIV , 2009, Journal of the International AIDS Society.

[9]  S. Lawn,et al.  Immune reconstitution and "unmasking" of tuberculosis during antiretroviral therapy. , 2008, American journal of respiratory and critical care medicine.

[10]  B. D. de Jong,et al.  Treatment outcomes of patients with HIV and tuberculosis. , 2007, American journal of respiratory and critical care medicine.

[11]  A. Harries,et al.  How can the community contribute in the fight against HIV/AIDS and tuberculosis? An example from a rural district in Malawi. , 2006, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[12]  R. Zachariah,et al.  High acceptability of voluntary counselling and HIV‐testing but unacceptable loss to follow up in a prevention of mother‐to‐child HIV transmission programme in rural Malawi: scaling‐up requires a different way of acting , 2005, Tropical medicine & international health : TM & IH.

[13]  A. Harries,et al.  Tuberculosis and HIV interaction in sub‐Saharan Africa: impact on patients and programmes; implications for policies , 2005, Tropical medicine & international health : TM & IH.

[14]  C. Dye,et al.  Effects of human immunodeficiency virus infection on recurrence of tuberculosis after rifampin-based treatment: an analytical review. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  A. Harries,et al.  Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo, Malawi , 2003, AIDS.

[16]  R. Wood,et al.  Effect of highly active antiretroviral therapy on incidence of tuberculosis in South Africa: a cohort study , 2002, The Lancet.

[17]  J. Musila.  An econometric model of the Malawian economy , 2002 .

[18]  P. Sonnenberg,et al.  HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: a cohort study in South African mineworkers , 2001, The Lancet.

[19]  A. Harries,et al.  Deaths from tuberculosis in sub-Saharan African countries with a high prevalence of HIV-1 , 2001, The Lancet.

[20]  Jeffrey L. Jones,et al.  HIV-associated tuberculosis in the era of highly active antiretroviral therapy. The Adult/Adolescent Spectrum of HIV Disease Group. , 2000, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[21]  G. Ippolito,et al.  Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection , 2000, AIDS.

[22]  R. Luzzati,et al.  NOSOCOMIAL EPIDEMIC OF ACTIVE TUBERCULOSIS AMONG HIV-INFECTED PATIENTS , 1989, The Lancet.

[23]  A. Harries,et al.  Tuberculosis and HIV: current status in Africa. , 1997, AIDS.

[24]  A. Grant,et al.  Natural history and spectrum of disease in adults with HIV/AIDS in Africa. , 1997, AIDS.