Open AccessAnti‐retroviral therapy scale‐up and its impact on sex‐stratified tuberculosis notification trends in Uganda
Author(s) -
ZaweddeMuyanja Stella,
Manabe Yukari C,
Musaazi Joseph,
Mugabe Frank R,
Ross Jennifer M,
Hermans Sabine
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25394
Subject(s) - medicine , tuberculosis , demography , poisson regression , population , antiretroviral therapy , incidence (geometry) , human immunodeficiency virus (hiv) , environmental health , viral load , family medicine , pathology , physics , sociology , optics
In order to end the tuberculosis ( TB ) epidemic by 2035, countries must achieve a 10% annual decline in tuberculosis incidence rates by 2025. Provision of antiretroviral therapy ( ART ) has been associated with population level decreases in TB notification rates. We aimed to assess whether the progressive scale‐up of ART provision over the past nine years has had an effect on population level trends of TB notification in Uganda stratified by sex and HIV status. Methods The study area consisted of Kampala and eight surrounding districts. Annual TB notifications and mid‐year populations were used to calculate notification rates per 100,000 population from the study area. Numbers alive and retained on ART were used to calculate ART coverage, overall and by sex. TB notification rates ( TBNR s) overall and stratified by sex and HIV status were calculated for the period 2009 to 2017. Trends in TBNR s before and after rollout of universal ART for pregnant women in 2013 were examined using Poisson regression models. To gain insight into the trends in CD 4+ T‐cell counts at ART initiation over the study period, we performed a sub analysis of patient level data from the Infectious Diseases Institute clinic. Results From 2009 to 2017, ART coverage increased by 27.6% among men and by 35.4% among women. TBNR s declined during the same period. Overall, the average annual percentage decline in TBNR s was −3.5% (95% CI −3.7% to −3.3%), (−2.3% (95% CI −2.6% to −1.9%) in men and −5.4% (95% CI −5.7% to −5.0%) in women). ART coverage increased after 2013 but this was not associated with an accelerated decline in overall TBNR s among HIV ‐positive persons −3.6% before 2013 and −5.2% after 2013; p = 0.33. The proportion of patients initiating ART with CD 4+ T‐cell count ≤ 200 cells/ mL did not decrease significantly after 2013 (42.2% to 32.2% , p = 0.05). Conclusions Although ART scale‐up was temporally associated with a decline in TB notification rates, the achieved rates of decline are below those required to achieve the End TB Targets. Additional investments in tuberculosis control should include efforts to promote earlier care seeking and ART initiation among HIV ‐positive persons.