Declining tuberculosis incidence among people receiving HIV care and treatment services in East Africa, 2007-2012

Suzue Saito, Philani Mpofu, E. Jane Carter, Lameck Diero, Kara Wools-Kaloustian, Constantin Yiannoutsos, Musick S. Beverly, Simon Tsiouris, Geoffrey R. Somi, John Ssali, Denis Nash, Batya Elul

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 signifi-cantly 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.

Original languageEnglish (US)
Pages (from-to)e96-e106
JournalJournal of Acquired Immune Deficiency Syndromes
Volume71
Issue number4
DOIs
StatePublished - 2016

Fingerprint

Eastern Africa
Tuberculosis
HIV
Incidence
Therapeutics
Uganda
Tanzania
Kenya
Isoniazid
Population
Africa South of the Sahara
Proportional Hazards Models

Keywords

  • ART
  • HIV
  • Sub-Saharan Africa
  • TB incidence rates
  • TB/HIV
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Declining tuberculosis incidence among people receiving HIV care and treatment services in East Africa, 2007-2012. / Saito, Suzue; Mpofu, Philani; Jane Carter, E.; Diero, Lameck; Wools-Kaloustian, Kara; Yiannoutsos, Constantin; Beverly, Musick S.; Tsiouris, Simon; Somi, Geoffrey R.; Ssali, John; Nash, Denis; Elul, Batya.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 71, No. 4, 2016, p. e96-e106.

Research output: Contribution to journalArticle

Saito, Suzue ; Mpofu, Philani ; Jane Carter, E. ; Diero, Lameck ; Wools-Kaloustian, Kara ; Yiannoutsos, Constantin ; Beverly, Musick S. ; Tsiouris, Simon ; Somi, Geoffrey R. ; Ssali, John ; Nash, Denis ; Elul, Batya. / Declining tuberculosis incidence among people receiving HIV care and treatment services in East Africa, 2007-2012. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 71, No. 4. pp. e96-e106.
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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 signifi-cantly 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.",
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AU - Wools-Kaloustian, Kara

AU - Yiannoutsos, Constantin

AU - Beverly, Musick S.

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AU - Nash, Denis

AU - Elul, Batya

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