@article{f22bdef6f29845049bbce8352ea932f9,
title = "Anti-retroviral therapy scale-up and its impact on sex-stratified tuberculosis notification trends in Uganda",
abstract = "Introduction: 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 (TBNRs) overall and stratified by sex and HIV status were calculated for the period 2009 to 2017. Trends in TBNRs 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 CD4+ 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. TBNRs declined during the same period. Overall, the average annual percentage decline in TBNRs 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 TBNRs among HIV-positive persons −3.6% before 2013 and −5.2% after 2013; p = 0.33. The proportion of patients initiating ART with CD4+ 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.",
keywords = "Uganda, antiretroviral therapy, notification trends, policy, sex, tuberculosis",
author = "Stella Zawedde-Muyanja and Manabe, {Yukari C.} and Joseph Musaazi and Mugabe, {Frank R.} and Ross, {Jennifer M.} and Sabine Hermans",
note = "Funding Information: The authors received funding from the following sources during the drafting of this manuscript: SZM and YCM received support from the Fogarty International Center, National Institutes for Health: Grant # D43TW009771 “HIV Co-infections in Uganda: TB, Cryptococcus and Viral Hepatitis.” SZM received funding from the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [grant # DEL-15-006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant # 107752/Z/15/Z] and the UK government, received funding from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (K01AI138620). We particularly thank the NTLP and the ACP for providing the data analysed for this study. The authors received funding from the following sources during the drafting of this manuscript: SZM and YCM received support from the Fogarty International Center, National Institutes for Health: Grant # D43TW009771 “HIV Co-infections in Uganda: TB, Cryptococcus and Viral Hepatitis.” SZM received funding from the Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [grant # DEL-15-006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant # 107752/Z/15/Z] and the UK government, received funding from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (K01AI138620). We particularly thank the NTLP and the ACP for providing the data analysed for this study. Funding Information: The authors received funding from the following sources during the drafting of this manuscript: SZM and YCM received support from the Fogarty International Center, National Institutes for Health: Grant # D43TW009771 “HIV Co‐infections in Uganda: TB, Cryptococcus and Viral Hepatitis.” SZM received funding from the Sub‐Saharan African Network for TB/HIV Research Excellence (SANTHE), a DELTAS Africa Initiative [grant # DEL‐15‐006]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [grant # 107752/Z/15/Z] and the UK government, received funding from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (K01AI138620). We particularly thank the NTLP and the ACP for providing the data analysed for this study. Publisher Copyright: {\textcopyright} 2019 Infectious Diseases Institute. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.",
year = "2019",
month = sep,
day = "1",
doi = "10.1002/jia2.25394",
language = "English (US)",
volume = "22",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",
number = "9",
}