The Impact of Anti-Retroviral Therapy on Tuberculosis Detection at the National Level in South Africa.
Am J Trop Med Hyg
; 99(6): 1407-1414, 2018 12.
Article
em En
| MEDLINE
| ID: mdl-30277200
ABSTRACT
Human immunodeficiency virus/tuberculosis (HIV/TB) coinfection is particularly prevalent in South Africa, where TB has been the leading cause of death for more than a decade. The 2004-2008 national rollout of antiretroviral therapy (ART) provides a unique opportunity to examine the population-level impact of ART on the TB epidemic. We performed longitudinal regression analysis to follow the evolution of TB outcomes before and after the introduction of ART using a large data set from the National Health Laboratory Service. This is the first study to produce estimates of the impact of the ART rollout by exploiting staggered timing and geographic variation in the rollout. After ART became available in a health facility, 3.7% (P < 0.0001) more patients were tested for TB and 3.2% (P < 0.0001) more received repeat testing; however, there was a steep rise in testing before the introduction of ART. Although the number of TB-positive patients increased by 4.3% (P = 0.0002) in the first year post-ART, the TB rate among tested patients fell by 2 percentage points (8%, P = 0.001) after 2 years. Sputum smear testing declined relative to more technologically advanced diagnostics post-ART. Antiretroviral therapy availability increased the attention to TB screening and drew new patients into the health-care system. Small increases in the numbers of repeat patients are indicative of retention in care. The decline in TB rates post-ART suggests that the reduction in TB risk due to improved immune functioning and health-care contact likely outweighed the increased TB risk because of the longer lifespan of ART initiators.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Modelos Estatísticos
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HIV
/
Tuberculose Resistente a Múltiplos Medicamentos
/
Fármacos Anti-HIV
/
Mycobacterium tuberculosis
/
Antituberculosos
Tipo de estudo:
Diagnostic_studies
/
Prevalence_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
/
Male
País/Região como assunto:
Africa
Idioma:
En
Revista:
Am J Trop Med Hyg
Ano de publicação:
2018
Tipo de documento:
Article