Declining tuberculosis case notification rates with the scale-up of antiretroviral therapy in Zimbabwe.
Setting:Zimbabwe has a human immunodeficiency virus (HIV) driven tuberculosis (TB) epidemic, with antiretroviral therapy (ART) scaled up in the public sector since 2004.Objective:To determine whether national ART scale-up was associated with annual national TB case notification rates (CNR), stratified by disease type and category, between 2000 and 2013.Design:This was a retrospective study using aggregate data from global reports.Results:The number of people living with HIV and retained on ART from 2004 to 2013 increased from 8400 to 665 299, with ART coverage increasing from <0.5% to 48%. TB CNRs, all types and categories, increased from 2000 to 2003, and declined thereafter from 2004 to 2013. The decreases in annual TB notifications between the highest rates (before 2004) and lowest rates (2013) were all forms of TB (56%), new TB (60%), previously treated TB (53%), new smear-positive pulmonary TB (PTB) (40%), new smear-negative/smear-unknown PTB (58%) and extra-pulmonary TB (58%).Conclusion:Significant declines in TB CNRs were observed during ART scale-up, especially for smear-negative PTB and extra-pulmonary TB. These encouraging national trends support the continued scale-up of ART for people living with HIV as a way of tackling the twin epidemics of HIV/acquired immune-deficiency syndrome and TB in Zimbabwe.
AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe ; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
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Takarinda
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
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Harries
AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
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Sandy
AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
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Mutasa-Apollo
The Union, Harare, Zimbabwe.
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Zishiri
ART; HIV/AIDS; Zimbabwe; operational research; recurrent TB; tuberculosis
Trop Med Int Health. 2016 Jan;21(1):101-107
26509352
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD000171
20091503
PLoS Med. 2012;9(7):e1001270
22911011
Public Health Action. 2015 Jun 21;5(2):103-5
26400378
Clin Infect Dis. 2012 May;54(9):1364-72
22460971
Int J Tuberc Lung Dis. 2011 Jul;15(7):933-7
21682967
Arch Intern Med. 2003 May 12;163(9):1009-21
12742798
AIDS. 2007 Jul 11;21(11):1441-8
17589190
AIDS. 2012 Nov 13;26(17):2233-9
22951633
Lancet. 2014 Aug 23;384(9944):682-90
24835842
PLoS One. 2012;7(3):e34156
22479548
Sex Transm Infect. 2004 Aug;80 Suppl 1:i5-9
15249692
Public Health Action. 2014 Jun 21;4(2):113-5
26399210