Implementation and Operational Research
| Autor: | Constantin T. Yiannoutsos, Denis Nash, E. Jane Carter, Kara Wools-Kaloustian, Philani Mpofu, Geoffrey Somi, Batya Elul, Simon Tsiouris, John Ssali, Lameck Diero, Suzue Saito, Musick S. Beverly |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Time Factors Tuberculosis Adolescent Anti-HIV Agents 030231 tropical medicine Population HIV Infections Tanzania Article Young Adult 03 medical and health sciences 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) Environmental health medicine Humans Uganda Pharmacology (medical) 030212 general & internal medicine Young adult education Retrospective Studies education.field_of_study biology Proportional hazards model business.industry Incidence Incidence (epidemiology) Retrospective cohort study Middle Aged biology.organism_classification medicine.disease Kenya Infectious Diseases Female business |
| Zdroj: | JAIDS Journal of Acquired Immune Deficiency Syndromes. 71:e96-e106 |
| ISSN: | 1525-4135 |
| DOI: | 10.1097/qai.0000000000000896 |
| Popis: | 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. 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. 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. Annual TB incidence rates among PLWH significantly 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. |
| Databáze: | OpenAIRE |
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