Decreased risk of HIV‐associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population‐based analysis

Kerschberger, Bernhard; Schomaker, Michael; Telnov, Alex; Vambe, Debrah; Kisyeri, Nicholas; Sikhondze, Welile; Pasipamire, Lorraine; Ngwenya, Siphiwe; Rusch, Barbara; Ciglenečki, Iza; Boulle, Andrew

doi:10.1111/tmi.13290

Cited by 7 publications

(9 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Through the introduction of advanced diagnostic techniques, like the GeneXpert, confirmatory diagnosis greatly improved. The number of cases notified and enrolled on TB treatment have been steadily declining at an average of 18%–15% per annum in Eswatini since 2010 [ 9 , 10 ]. In 2018, a total of 3151 TB cases were notified in the country and 1900 cases were reported by the end of 2021 [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Tuberculosis Case Notification and Treatment Outcomes in Eswatini

Masina

Lin

Chien

2022

Int J Public Health

View full text Add to dashboard Cite

Objectives: We investigated the impact of COVID-19 on tuberculosis (TB) case notification and treatment outcomes in Eswatini.Methods: A comparative retrospective cohort study was conducted using TB data from eight facilities. An interrupted time series analysis, using segmented Poisson regression was done to assess the impact of COVID-19 on TB case notification comparing period before (December 2018-February 2020, n = 1,560) and during the pandemic (March 2020–May 2021, n = 840). Case notification was defined as number of TB cases registered in the TB treatment register. Treatment outcomes was result assigned to patients at the end of treatment according to WHO rules.Results: There was a significant decrease in TB case notification (IRR 0.71, 95% CI: 0.60–0.83) and a significant increase in death rate among registrants during the pandemic (21.3%) compared to pre-pandemic (10.8%, p < 0.01). Logistic regression indicated higher odds of unfavorable outcomes (death, lost-to-follow-up, and not evaluated) during the pandemic than pre-pandemic (aOR 2.91, 95% CI: 2.17–3.89).Conclusion: COVID-19 negatively impacted TB services in Eswatini. Eswatini should invest in strategies to safe-guard the health system against similar pandemics.

show abstract

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on Tuberculosis Case Notification and Treatment Outcomes in Eswatini

Masina

Lin

Chien

2022

Int J Public Health

View full text Add to dashboard Cite

show abstract

“…While Eswatini has a high burden of TB and HIV, recent years have seen a sharp decrease in TB incidence, dropping from a high of 1,190 cases per 100,000 in 2010 to 363 per 100,000 in 2019, and in 2017, during the period of program implementation, incidence was 502 per 100,0000 [4]. This decrease has been attributed to improvements in ICF with task shifting for TB screening, introduction of Xpert MTB/RIF for TB diagnosis, and implementation of TPT and infection prevention and control measures [17,18], as well as expanded ART coverage, which increased from 34% in 2010 to over 95% in 2019 [19]. Eswatini had an estimated TB case detection rate of 69% in 2019 [1], thus opportunities remain for early identification of individuals with TB through systematic TB screening and diagnosis at expanded entry points.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini

Teasdale

Pasipamire²,

Ao³

et al. 2022

PLOS Glob Public Health

View full text Add to dashboard Cite

Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.

show abstract

“…Although regional drug‐sensitive and drug‐resistant TB notifications declined fivefold from 1341 to 269 cases per 100,000 population between 2009 and 2016, HIV co‐infection among TB cases remained high at ~71% [14]. Figure 1 summarises the main programmatic interventions implemented in the region [14, 22, 23]. HIV and TB care initially centralised at three secondary care facilities in 2008, was—with the support of Médecins sans Frontières (MSF)—decentralised to 22 nurse‐led and medical doctor‐supported primary care clinics between 2009 and 2011.…”

Section: Methodsmentioning

confidence: 99%

“…The region had a high HIV prevalence of 26% in ≥15-year-olds in 2017 [21]. Although regional drug-sensitive and drug-resistant TB notifications declined fivefold from 1341 to 269 cases per 100,000 population between 2009 and 2016, HIV coinfection among TB cases remained high at $71% [14]. Figure 1 summarises the main programmatic interventions implemented in the region [14,22,23].…”

Section: Settingmentioning

confidence: 99%

“…For instance, these concerted efforts improved the quality and comprehensiveness of TB care, resulting in a decrease in TB notifications and improved treatment outcomes in Eswatini between 2009 and 2016 [13,14]. However, many resource-limited settings (RLS) sustained high TB mortality at population level (e.g., >20 deaths per 100,000 population in Southern Africa in 2019) [1], and particular in TB patients co-infected with HIV [1,13,15].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini

Kerschberger,

Vambe,

Schomaker

et al. 2023

Tropical Med Int Health

Self Cite

View full text Add to dashboard Cite

ObjectivesDespite declining TB notifications in Southern Africa, TB‐related deaths remain high. We describe patient‐ and population‐level trends in TB‐related deaths in Eswatini over a period of 11 years.MethodsPatient‐level (retrospective cohort, from 2009 to 2019) and population‐level (ecological analysis, 2009–2017) predictors and rates of TB‐related deaths were analysed in HIV‐negative and HIV‐coinfected first‐line TB treatment cases and the population of the Shiselweni region. Patient‐level TB treatment data, and population and HIV prevalence estimates were combined to obtain stratified annual mortality rates. Multivariable Poisson regressions models were fitted to identify patient‐level and population‐level predictors of deaths.ResultsOf 11,883 TB treatment cases, 1302 (11.0%) patients died during treatment: 210/2798 (7.5%) HIV‐negative patients, 984/8443 (11.7%) people living with HIV (PLHIV), and 108/642 (16.8%) patients with unknown HIV‐status. The treatment case fatality ratio remained above 10% in most years. At patient‐level, fatality risk was higher in PLHIV (aRR 1.74, 1.51–2.02), and for older age and extra‐pulmonary TB irrespective of HIV‐status. For PLHIV, fatality risk was higher for TB retreatment cases (aRR 1.38, 1.18–1.61) and patients without antiretroviral therapy (aRR 1.70, 1.47–1.97). It decreases with increasing higher CD4 strata and the programmatic availability of TB‐LAM testing (aRR 0.65, 0.35–0.90). At population‐level, mortality rates decreased 6.4‐fold (−147/100,000 population) between 2009 (174/100,000) and 2017 (27/100,000), coinciding with a decline in TB treatment cases (2785 in 2009 to 497 in 2017). Although the absolute decline in mortality rates was most pronounced in PLHIV (−826/100,000 vs. HIV‐negative: −23/100,000), the relative population‐level mortality risk remained higher in PLHIV (aRR 4.68, 3.25–6.72) compared to the HIV‐negative population.ConclusionsTB‐related mortality rapidly decreased at population‐level and most pronounced in PLHIV. However, case fatality among TB treatment cases remained high. Further strategies to reduce active TB disease and introduce improved TB therapies are warranted.

show abstract

Decreased risk of HIV‐associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population‐based analysis

Cited by 7 publications

References 55 publications

The Impact of the COVID-19 Pandemic on Tuberculosis Case Notification and Treatment Outcomes in Eswatini

The Impact of the COVID-19 Pandemic on Tuberculosis Case Notification and Treatment Outcomes in Eswatini

Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini

Sustained high fatality during TB therapy amid rapid decline in TB mortality at population level: A retrospective cohort and ecological analysis from Shiselweni, Eswatini

Contact Info

Product

Resources

About