title: Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi.
abstract: 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.
authors.affiliation: Médecins Sans Frontières (MSF), Medical Department (Operational Research), MSF-Luxembourg, Brussels Operational Centre, Luxembourg. zachariah@internet.lu
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.forename: M
authors.initials: M
authors.lastname: Bemelmans
authors.forename: A
authors.initials: A
authors.lastname: Akesson
authors.forename: P
authors.initials: P
authors.lastname: Gomani
authors.forename: K
authors.initials: K
authors.lastname: Phiri
authors.forename: B
authors.initials: B
authors.lastname: Isake
authors.forename: T
authors.initials: T
authors.lastname: van den Akker
authors.forename: M
authors.initials: M
authors.lastname: Philips
authors.forename: A
authors.initials: A
authors.lastname: Mwale
authors.forename: F
authors.initials: F
authors.lastname: Gausi
authors.forename: J
authors.initials: J
authors.lastname: Kwanjana
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018563:Disease Notification / Q000706:statistics & numerical data; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D019380:Anti-HIV Agents