title: Scale-up of ART in Malawi has reduced case notification rates in HIV-positive and HIV-negative tuberculosis.
abstract: Setting:For 30 years, Malawi has experienced a dual epidemic of human immunodeficiency virus (HIV) infection and tuberculosis (TB) that has recently begun to be attenuated by the scale-up of antiretroviral therapy (ART).Objective:To report on the correlation between ART scale-up and annual national TB case notification rates (CNR) in Malawi, stratified by HIV-positive and HIV-negative status, from 2005 to 2015.Design:A retrospective descriptive ecological study using aggregate data from national reports.Results:From 2005 to 2015, ART was scaled up in Malawi from 28 470 to 618 488 total patients, with population coverage increasing from 2.4% to 52.2%. During this time, annual TB notifications declined by 35%, from 26 344 to 17 104, and the TB CNR per 100 000 population declined by 49%, from 206 to 105. HIV testing uptake increased from 51% to 92%. In known HIV-positive TB patients, the CNR decreased from a high of 1247/100 000 to 710/100 000, a 43% decrease. In known HIV-negative TB patients, the CNR also decreased, from a high of 66/100 000 to 49/100 000, a 26% decrease.Conclusion:TB case notifications have continued to decline in association with ART scale-up, with the decline seen more in HIV-positive than HIV-negative TB. These findings have programmatic implications for national TB control efforts.
authors.affiliation: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi.
authors.forename: H
authors.initials: H
authors.lastname: Kanyerere
authors.affiliation: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi ; International Training and Education Center for Health (I-TECH) Malawi, Department of Global Health, University of Washington, Seattle, Washington, USA.
authors.forename: B
authors.initials: B
authors.lastname: Girma
authors.affiliation: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi.
authors.forename: J
authors.initials: J
authors.lastname: Mpunga
authors.affiliation: Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Luxembourg City, Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: International Training and Education Center for Health (I-TECH) Malawi, Department of Global Health, University of Washington, Seattle, Washington, USA ; Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Jahn
authors.affiliation: Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi.
authors.forename: F M
authors.initials: FM
authors.lastname: Chimbwandira
keywords: HIV/AIDS; Malawi; TB; antiretroviral therapy; human immunodeficiency virus