title: Potential impact of the US President's Emergency Plan for AIDS relief on the tuberculosis/HIV coepidemic in selected Sub-Saharan African countries.
abstract: BACKGROUND
  There are limited data measuring the impact of expanded human immunodeficiency virus (HIV) prevention activities on the tuberculosis epidemic at the country level. Here, we characterized the potential impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) on the tuberculosis epidemic in sub-Saharan Africa.
  
  
  METHODS
  We selected 12 focus countries (countries receiving the greatest US government investments) and 29 nonfocus countries (controls). We used tuberculosis incidence and mortality rates and relative risks to compare time periods before and after PEPFAR's inception, and a tuberculosis/HIV indicator to calculate the rate of change in tuberculosis incidence relative to the HIV prevalence.
  
  
  RESULTS
  Comparing the periods before and after PEPFAR's implementation, both tuberculosis incidence and mortality rates have diminished significantly and to a higher degree in focus countries. The relative risk for developing tuberculosis, comparing those with and without HIV, was 22.5 for control and 20.0 for focus countries. In most focus countries, the tuberculosis epidemic is slowing down despite some regions still experiencing an increase in HIV prevalence.
  
  
  CONCLUSIONS
  This ecological study showed that PEPFAR had a more consistent and substantial effect on HIV and tuberculosis in focus countries, highlighting the likely link between high levels of HIV investment and broader effects on related diseases such as tuberculosis.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital.
authors.forename: Viviane D
authors.initials: VD
authors.lastname: Lima
authors.forename: Reuben
authors.initials: R
authors.lastname: Granich
authors.forename: Peter
authors.initials: P
authors.lastname: Phillips
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D003906:Developing Countries; D058872:Epidemics / Q000517:prevention & control; D014943:Global Health; D015658:HIV Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D007391:International Cooperation; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D014481:United States
keywords: HIV; PEPFAR; coepidemic; incidence; mortality; sub-Saharan Africa; tuberculosis
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