You are here

  • Home
  • Archive
  • Volume 10, Issue 4
  • Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018

Article Text

Article menu

Download PDFPDF

XML
Public health
Original research
Trend analysis of tuberculosis case notifications with scale-up of antiretroviral therapy and roll-out of isoniazid preventive therapy in Zimbabwe, 2000–2018
  1. Kudakwashe C Takarinda1,2,
  2. Anthony D Harries1,3,
  3. Tsitsi Mutasa-Apollo2,
  4. Charles Sandy2,
  5. Regis C Choto2,
  6. Simbarashe Mabaya4,
  7. Cephas Mbito2,
  8. Collins Timire1,2
  1. 1Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France
  2. 2AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
  3. 3Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  4. 4World Health Organization Country Office for Zimbabwe, Harare, Harare, Zimbabwe
  1. Correspondence to Dr Kudakwashe C Takarinda; kctakarinda{at}gmail.com

Abstract

Objectives Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018.

Design Ecological study using aggregate national data.

Setting Annual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT.

Results ART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001).

Conclusions This study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage.

  • HIV & AIDS
  • tuberculosis
  • public health
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-034721

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @ktakarinda

    • Contributors KCT and ADH conceived and designed the study, and TM-A, CS, RCC, SM, CM and CT read, revised and approved the study protocol. KCT collected the data and analysed them, while TM-A, CS, RCC, SM, CM and CT contributed to interpreting the data. KCT drafted the manuscript, and TM-A, CS, RCC, SM, CM and CT read, critically revised the manuscript for intellectual content and eventually approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Technical support was provided through the International Union Against Tuberculosis and Lung Disease (IUATLD). Kudakwashe Takarinda is supported as a Senior Operations Research Fellow from the Centre for Operational Research at the IUATLD, Paris, France.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval was sought and obtained from the Ministry of Health and Child Care, Harare, Zimbabwe and the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease, Paris, France.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Data for this study are freely available from the WHO website (https://www.who.int/tb/country/data/download/en/) for TB data and the UNAIDS website (http://aidsinfo.unaids.org) for ART coverage data. Alternatively data and the statistical code can be shared by the corresponding and lead author upon contacting him on email address kctakarinda@gmail.com.