Dangor Z., Izu A., Hillier K., Solomon F., Beylis N., Moore D.P., Nunes M.C., Madhi S.A.
Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; City of Hamilton Public Health Services, Hamilton, ON, Canada; Mycobacteriology Referral Laboratory, National Health Laboratory Service, Johannesburg, South Africa; National Institute for Communicable Diseases, Division of National Health Laboratory Service, Centre for Tuberculosis, 1 Modderfontein Road, Sandringham-Gauteng, 2131, South Africa
Dangor, Z., Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Izu, A., Department of Science and Technology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hillier, K., City of Hamilton Public Health Services, Hamilton, ON, Canada; Solomon, F., Department of Science and Technology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Beylis, N., Mycobacteriology Referral Laboratory, National Health Laboratory Service, Johannesburg, South Africa; Moore, D.P., Department of Science and Technology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Nunes, M.C., Department of Science and Technology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Madhi, S.A., Department of Science and Technology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, National Institute for Communicable Diseases, Division of National Health Laboratory Service, Centre for Tuberculosis, 1 Modderfontein Road, Sandringham-Gauteng, 2131, South Africa
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. © 2013 Lippincott Williams & Wilkins.
