Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018
Objectives Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level a...
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BMJ Publishing Group
2020-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/4/e034721.full |
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| author | Anthony D Harries Collins Timire Kudakwashe C Takarinda Simbarashe Mabaya Tsitsi Mutasa-Apollo Charles Sandy Regis C Choto Cephas Mbito |
| author_facet | Anthony D Harries Collins Timire Kudakwashe C Takarinda Simbarashe Mabaya Tsitsi Mutasa-Apollo Charles Sandy Regis C Choto Cephas Mbito |
| author_sort | Anthony D Harries |
| collection | DOAJ |
| description | Objectives Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018.Design Ecological study using aggregate national data.Setting Annual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT.Results ART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001).Conclusions This study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage. |
| format | Article |
| id | doaj-art-b26b90eb20f8447d8268c9cd8cbd43cd |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b26b90eb20f8447d8268c9cd8cbd43cd2024-12-04T00:45:08ZengBMJ Publishing GroupBMJ Open2044-60552020-04-0110410.1136/bmjopen-2019-034721Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018Anthony D Harries0Collins Timire1Kudakwashe C Takarinda2Simbarashe Mabaya3Tsitsi Mutasa-Apollo4Charles Sandy5Regis C Choto6Cephas Mbito7Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UKCenter for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, FranceAIDS and TB Department, Ministry of Health and Child Care, Harare, ZimbabweWorld Health Organization Regional Office for Africa, Harare, Harare, ZimbabweAIDS and TB Department, Ministry of Health and Child Care, Harare, ZimbabweAIDS and TB Department, Ministry of Health and Child Care, Harare, ZimbabweAIDS and TB Department, Ministry of Health and Child Care, Harare, ZimbabweAIDS and TB Department, Ministry of Health and Child Care, Harare, ZimbabweObjectives Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018.Design Ecological study using aggregate national data.Setting Annual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT.Results ART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001).Conclusions This study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage.https://bmjopen.bmj.com/content/10/4/e034721.full |
| spellingShingle | Anthony D Harries Collins Timire Kudakwashe C Takarinda Simbarashe Mabaya Tsitsi Mutasa-Apollo Charles Sandy Regis C Choto Cephas Mbito Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018 BMJ Open |
| title | Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018 |
| title_full | Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018 |
| title_fullStr | Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018 |
| title_full_unstemmed | Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018 |
| title_short | Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018 |
| title_sort | trend analysis of tuberculosis case notifications with scale up of antiretroviral therapy and roll out of isoniazid preventive therapy in zimbabwe 2000 2018 |
| url | https://bmjopen.bmj.com/content/10/4/e034721.full |
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