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

Kanyerere, Henry; Girma, Belaineh; Mpunga, James; Tayler‐Smith, Katie; Harries, Anthony; Jahn, Andreas; Chimbwandira, FM

doi:10.5588/pha.16.0053

Cited by 17 publications

(20 citation statements)

References 22 publications

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“…In Kenya and Malawi, declines in case notifications were also seen in HIV-negative TB, which might be due to overall decreases in HIVassociated TB leading to reduced transmission of MTB in the community. 23,27 It is plausible that part of the decrease in TB incidence observed since 2008 in countries mostly affected by the HIV epidemic could be attributable to the increase in ART coverage, as evidenced by the parallel decrease in HIV prevalence in notified TB cases in these countries. 6 This positive news from the programmatic front is supported by mathematical models predicting the enormous impact that immediate start of ART might have on TB prevention at the population level.…”

Section: Can Art Reduce Tb Incidence At the Programmatic Level?mentioning

confidence: 99%

Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

Harries

Schwoebel

Monedero-Recuero

et al. 2019

int j tuberc lung dis

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Section: Can Art Reduce Tb Incidence At the Programmatic Level?mentioning

confidence: 99%

Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

Harries

Schwoebel

Monedero-Recuero

et al. 2019

int j tuberc lung dis

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“…ART reverses the immune dysfunction associated with HIV and, as a result, has a potent TB-preventive effect 90 . At the program level, the increasing ART coverage in people living with HIV in Swaziland, Zimbabwe, and Malawi has been associated with a decrease in national TB case notification rates for both HIV-positive and HIV-negative persons 91 – 93 . Randomized controlled trials have shown that the effects of ART in reducing TB incidence may be augmented with the addition of isoniazid preventive therapy (IPT) 94 , 95 .…”

Section: Treat Latent Tuberculosis Infection In High-risk Groupsmentioning

confidence: 99%

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

et al. 2018

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The international community has committed to ending the tuberculosis (TB) epidemic by 2030. This will require multi-sectoral action with a focus on accelerating socio-economic development, developing and implementing new tools, and expanding health insurance coverage. Within this broad framework, National TB Programmes (NTPs) are accountable for delivering diagnostic, treatment, and preventive services. There are large gaps in the delivery of these services, and the aim of this article is to review the crucial activities and interventions that NTPs must implement in order to meet global targets and milestones that will end the TB epidemic. The key deliverables are the following: turn End TB targets and milestones into national measurable indicators to make it easier to track progress; optimize the prompt and accurate diagnosis of all types of TB; provide rapid, complete, and effective treatment to all those diagnosed with TB; implement and monitor effective infection control practices; diagnose and treat drug-resistant TB, associated HIV infection, and diabetes mellitus; design and implement active case finding strategies for high-risk groups and link them to the treatment of latent TB infection; engage with the private-for-profit sector; and empower the Central Unit of the NTP particularly in relation to data-driven supportive supervision, operational research, and sustained financing. The glaring gaps in the delivery of TB services must be remedied, and some of these gaps will require new paradigms and ways of working which include patient-centered and higher-quality services. There must also be fast-track ways of incorporating new diagnostic, treatment, and prevention tools into program activities so as to rapidly reduce TB incidence and mortality and meet the goal of ending TB by 2030.

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“…Given its proven individual-level effect, one would expect that the expansion of ART coverage would lead to the population-effect of declining TB incidence among PLHIV. Indeed, in Kenya, South Africa, and Malawi, TB notification rates among people with HIV are estimated to have declined substantially more than TB notification rates among people without HIV, concurrent with the expansion of ART coverage [ 15 – 18 ]. However, the extent to which this is true across the sub-Saharan African region is unclear.…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of antiretroviral therapy on tuberculosis notification rates among people with HIV: a descriptive analysis of 23 countries in sub-Saharan Africa, 2010–2015

et al. 2018

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BackgroundHIV is a major driver of the tuberculosis epidemic in sub-Saharan Africa. The population-level impact of antiretroviral therapy (ART) scale-up on tuberculosis rates in this region has not been well studied. We conducted a descriptive analysis to examine evidence of population-level effect of ART on tuberculosis by comparing trends in estimated tuberculosis notification rates, by HIV status, for countries in sub-Saharan Africa.MethodsWe estimated annual tuberculosis notification rates, stratified by HIV status during 2010–2015 using data from WHO, the Joint United Nations Programme on HIV/AIDS, and the United Nations Population Division. Countries were included in this analysis if they had ≥4 years of HIV prevalence estimates and ≥ 75% of tuberculosis patients with known HIV status. We compared tuberculosis notification rates among people living with HIV (PLHIV) and people without HIV via Wilcoxon rank sum test.ResultsAmong 23 included countries, the median annual average change in tuberculosis notification rates among PLHIV during 2010–2015 was -5.7% (IQR -6.9 to -1.7%), compared to a median change of -2.3% (IQR -4.2 to -0.1%) among people without HIV (p-value = 0.0099). Among 11 countries with higher ART coverage, the median annual average change in TB notification rates among PLHIV was -6.8% (IQR -7.6 to -5.7%) compared to a median change of -2.1% (IQR -6.0 to 0.7%) for PLHIV in 12 countries with lower ART coverage (p = 0.0106).ConclusionTuberculosis notification rates declined more among PLHIV than people without HIV, and have declined more in countries with higher ART coverage. These results are consistent with a population-level effect of ART on decreasing TB incidence among PLHIV. To further reduce TB incidence among PLHIV, additional scale-up of ART as well as greater use of isoniazid preventive therapy and active case-finding will be necessary.

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

Cited by 17 publications

References 22 publications

Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

Challenges and opportunities to prevent tuberculosis in people living with HIV in low-income countries

What can National TB Control Programmes in low- and middle-income countries do to end tuberculosis by 2030?

Assessing the impact of antiretroviral therapy on tuberculosis notification rates among people with HIV: a descriptive analysis of 23 countries in sub-Saharan Africa, 2010–2015

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