title: Impact of the antiretroviral treatment program on the burden of hospitalization for culture-confirmed tuberculosis in South African children: a time-series analysis.
abstract: BACKGROUND
  The HIV epidemic increased the burden of tuberculosis (TB) in sub-Saharan Africa. We evaluated the impact that scaling-up of the public-funded antiretroviral treatment (ART) program had on incidence of hospitalization for culture-confirmed and overall-TB in HIV-infected and HIV-uninfected children from 2005 to 2009.
  
  
  METHODS
  The study was undertaken in Soweto, South Africa, where ART coverage of HIV-infected children increased from 43% in 2005 to 84% by 2009. Trends in incidence of hospitalization for clinically diagnosed and culture-confirmed TB in children 3 months to <15 years of age, identified through laboratory and electronic databases, were analyzed by comparing crude incidence and regression analysis.
  
  
  RESULTS
  The incidence (per 100,000) of culture-confirmed TB declined by 63.1% from 2005 (69.8) compared with 2009 (25.8; P < 0.0001). This included a 70.6% reduction between 2005 and 2009 among HIV-infected children (incidence: 1566.3 versus 460.7, respectively; P < 0.0001) and 41.3% decrease in HIV-uninfected children (18.7 versus 11.0, respectively; P = 0.0003). The month-by-month rate of decline of culture-confirmed TB was 2.3% in HIV-infected and 1.1% in HIV-uninfected children over the study period. The residual burden of TB remained 42-fold greater in HIV-infected children, 78% of whom were severely immune compromised, compared with HIV-uninfected children by 2009.
  
  
  CONCLUSIONS
  Increase in ART coverage was associated with significant decline in TB hospitalizations in HIV-infected children. This reduction may also in part have been due to reduced Mycobacterium tuberculosis transmission resulting from increased ART access among HIV-infected adults, which may have contributed to the reduction of culture-confirmed TB in HIV-uninfected children.
authors.affiliation: From the *Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; †Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡City of Hamilton Public Health Services, Hamilton, Ontario, Canada; §Mycobacteriology Referral Laboratory, National Health Laboratory Service, Johannesburg, South Africa; and ¶National Institute for Communicable Diseases: a division of National Health Laboratory Service, Centre for Tuberculosis, Sandringham, South Africa.
authors.forename: Ziyaad
authors.initials: Z
authors.lastname: Dangor
authors.forename: Alane
authors.initials: A
authors.lastname: Izu
authors.forename: Kelty
authors.initials: K
authors.lastname: Hillier
authors.forename: Fatima
authors.initials: F
authors.lastname: Solomon
authors.forename: Natalie
authors.initials: N
authors.lastname: Beylis
authors.forename: David P
authors.initials: DP
authors.lastname: Moore
authors.forename: Marta C
authors.initials: MC
authors.lastname: Nunes
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D044966:Anti-Retroviral Agents