Ziyaad Dangor1, Alane Izu, Kelty Hillier, Fatima Solomon, Natalie Beylis, David P Moore, Marta C Nunes, Shabir A Madhi. 1. From the *Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; †Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases & Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‡City of Hamilton Public Health Services, Hamilton, Ontario, Canada; §Mycobacteriology Referral Laboratory, National Health Laboratory Service, Johannesburg, South Africa; and ¶National Institute for Communicable Diseases: a division of National Health Laboratory Service, Centre for Tuberculosis, Sandringham, South Africa.
Abstract
BACKGROUND: The HIV epidemic increased the burden of tuberculosis (TB) in sub-Saharan Africa. We evaluated the impact that scaling-up of the public-funded antiretroviral treatment (ART) program had on incidence of hospitalization for culture-confirmed and overall-TB in HIV-infected and HIV-uninfected children from 2005 to 2009. METHODS: The study was undertaken in Soweto, South Africa, where ART coverage of HIV-infected children increased from 43% in 2005 to 84% by 2009. Trends in incidence of hospitalization for clinically diagnosed and culture-confirmed TB in children 3 months to <15 years of age, identified through laboratory and electronic databases, were analyzed by comparing crude incidence and regression analysis. RESULTS: The incidence (per 100,000) of culture-confirmed TB declined by 63.1% from 2005 (69.8) compared with 2009 (25.8; P < 0.0001). This included a 70.6% reduction between 2005 and 2009 among HIV-infected children (incidence: 1566.3 versus 460.7, respectively; P < 0.0001) and 41.3% decrease in HIV-uninfected children (18.7 versus 11.0, respectively; P = 0.0003). The month-by-month rate of decline of culture-confirmed TB was 2.3% in HIV-infected and 1.1% in HIV-uninfected children over the study period. The residual burden of TB remained 42-fold greater in HIV-infected children, 78% of whom were severely immune compromised, compared with HIV-uninfected children by 2009. CONCLUSION: Increase in ART coverage was associated with significant decline in TB hospitalizations in HIV-infected children. This reduction may also in part have been due to reduced Mycobacterium tuberculosis transmission resulting from increased ART access among HIV-infected adults, which may have contributed to the reduction of culture-confirmed TB in HIV-uninfected children.
BACKGROUND: The HIV epidemic increased the burden of tuberculosis (TB) in sub-Saharan Africa. We evaluated the impact that scaling-up of the public-funded antiretroviral treatment (ART) program had on incidence of hospitalization for culture-confirmed and overall-TB in HIV-infected and HIV-uninfectedchildren from 2005 to 2009. METHODS: The study was undertaken in Soweto, South Africa, where ART coverage of HIV-infectedchildren increased from 43% in 2005 to 84% by 2009. Trends in incidence of hospitalization for clinically diagnosed and culture-confirmed TB in children 3 months to <15 years of age, identified through laboratory and electronic databases, were analyzed by comparing crude incidence and regression analysis. RESULTS: The incidence (per 100,000) of culture-confirmed TB declined by 63.1% from 2005 (69.8) compared with 2009 (25.8; P < 0.0001). This included a 70.6% reduction between 2005 and 2009 among HIV-infectedchildren (incidence: 1566.3 versus 460.7, respectively; P < 0.0001) and 41.3% decrease in HIV-uninfectedchildren (18.7 versus 11.0, respectively; P = 0.0003). The month-by-month rate of decline of culture-confirmed TB was 2.3% in HIV-infected and 1.1% in HIV-uninfectedchildren over the study period. The residual burden of TB remained 42-fold greater in HIV-infectedchildren, 78% of whom were severely immune compromised, compared with HIV-uninfectedchildren by 2009. CONCLUSION: Increase in ART coverage was associated with significant decline in TB hospitalizations in HIV-infectedchildren. This reduction may also in part have been due to reduced Mycobacterium tuberculosis transmission resulting from increased ART access among HIV-infected adults, which may have contributed to the reduction of culture-confirmed TB in HIV-uninfectedchildren.
Authors: B Zeldow; S Kim; G McSherry; M F Cotton; P Jean-Philippe; A Violari; R Bobat; S Nachman; L M Mofenson; S A Madhi; C Mitchell Journal: Int J Tuberc Lung Dis Date: 2017-01-01 Impact factor: 2.373
Authors: Ziyaad Dangor; Alane Izu; David P Moore; Marta C Nunes; Fatima Solomon; Natalie Beylis; Anne von Gottberg; Johanna M McAnerney; Shabir A Madhi Journal: PLoS One Date: 2014-03-11 Impact factor: 3.240
Authors: Linda Barlow-Mosha; Victor Musiime; Mary-Ann Davies; Andrew J Prendergast; Philippa Musoke; George Siberry; Martina Penazzato Journal: J Int AIDS Soc Date: 2017-06-27 Impact factor: 5.396
Authors: David P Moore; Melissa M Higdon; Laura L Hammitt; Christine Prosperi; Andrea N DeLuca; Pedro Da Silva; Vicky L Baillie; Peter V Adrian; Azwifarwi Mudau; Maria Deloria Knoll; Daniel R Feikin; David R Murdoch; Katherine L O'Brien; Shabir A Madhi Journal: Clin Infect Dis Date: 2017-06-15 Impact factor: 9.079
Authors: Sharon Nachman; Amina Ahmed; Farhana Amanullah; Mercedes C Becerra; Radu Botgros; Grania Brigden; Renee Browning; Elizabeth Gardiner; Richard Hafner; Anneke Hesseling; Cleotilde How; Patrick Jean-Philippe; Erica Lessem; Mamodikoe Makhene; Nontombi Mbelle; Ben Marais; Helen McIlleron; David F McNeeley; Carl Mendel; Stephen Murray; Eileen Navarro; E Gloria Anyalechi; Ariel R Porcalla; Clydette Powell; Mair Powell; Mona Rigaud; Vanessa Rouzier; Pearl Samson; H Simon Schaaf; Seema Shah; Jeff Starke; Soumya Swaminathan; Eric Wobudeya; Carol Worrell Journal: Lancet Infect Dis Date: 2015-05-06 Impact factor: 25.071