title: Implementation and Operational Research: Declining Tuberculosis Incidence Among People Receiving HIV Care and Treatment Services in East Africa, 2007-2012.
abstract: BACKGROUND
  Antiretroviral therapy (ART) reduces the risk of Tuberculosis (TB) among people living with HIV (PLWH). With ART scale-up in sub-Saharan Africa over the past decade, incidence of TB among PLWH engaged in HIV care is predicted to decline.
  
  
  METHODS
  We conducted a retrospective analysis of routine clinical data from 168,330 PLWH receiving care at 35 facilities in Kenya, Tanzania, and Uganda during 2003-2012, participating in the East African region of the International Epidemiologic Databases to Evaluate AIDS. Temporal trends in facility-based annual TB incidence rates (per 100,000 person years) among PLWH and country-specific standardized TB incidence ratios using annual population-level TB incidence data from the World Health Organization were computed between 2007 and 2012. We examined patient-level and facility-level factors associated with incident TB using multivariable Cox models.
  
  
  RESULTS
  Overall, TB incidence rates among PLWH in care declined 5-fold between 2007 and 2012 from 5960 to 985 per 100,000 person years [P = 0.0003] (Kenya: 7552 to 1115 [P = 0.0007]; Tanzania: 7153 to 635 [P = 0.0025]; Uganda: 3204 to 242 [P = 0.018]). Standardized TB incidence ratios significantly decreased in the 3 countries, indicating a narrowing gap between incidence rates among PLWH and the general population. We observed lower hazards of incident TB among PLWH on ART and/or isoniazid preventive therapy and receiving care in facilities offering TB treatment onsite.
  
  
  CONCLUSIONS
  Annual TB incidence rates among PLWH significantly declined during ART scale-up but remained higher than the general population. Increasing access to ART and isoniazid preventive therapy and co-location of HIV and TB treatment may further reduce TB incidence among PLWH.
authors.affiliation: *ICAP at Columbia University, New York, NY; †Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN; ‡Warren Alpert School of Medicine, Brown University, Providence, RI; §School of Medicine, Moi University, Eldoret, Kenya; ‖Academic Model Providing Access to Health Care (AMPATH), Eldoret, Kenya; ¶Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN; #Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, IN; **Currently Ridgewood Infectious Diseases, Ridgewood, NJ; ††National AIDS Control Programme (NACP), Dar-es-Salaam, Tanzania; ‡‡Masaka Regional Referral Hospital, Masaka, Uganda; §§Epidemiology and Biostatistics Program at the CUNY School of Public Health, New York, NY; and ‖‖Department of Epidemiology, Mailman School of Public Health, Columbia University, ICAP at Columbia University, New York, NY.
authors.forename: Suzue
authors.initials: S
authors.lastname: Saito
authors.forename: Philani
authors.initials: P
authors.lastname: Mpofu
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Carter
authors.forename: Lameck
authors.initials: L
authors.lastname: Diero
authors.forename: Kara K
authors.initials: KK
authors.lastname: Wools-Kaloustian
authors.forename: Constantin T
authors.initials: CT
authors.lastname: Yiannoutsos
authors.forename: Musick S
authors.initials: MS
authors.lastname: Beverly
authors.forename: Simon
authors.initials: S
authors.lastname: Tsiouris
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Somi
authors.forename: John
authors.initials: J
authors.lastname: Ssali
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.forename: Batya
authors.initials: B
authors.lastname: Elul
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents