Potential impact of the us president's emergency plan for AIDS relief on the tuberculosis/HIV coepidemic in selected sub-Saharan African countries
Journal of Infectious Diseases
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland; Division of Infectious Diseases, University of British Columbia, Vancouver, Canada; South African Centre for Epidemiological Modelling and Analysis, Stellenbosch, South Africa
Background. There are limited data measuring the impact of expanded human immunodeficiency virus (HIV) prevention activities on the tuberculosis epidemic at the country level. Here, we characterized the potential impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) on the tuberculosis epidemic in sub-Saharan Africa. Methods. We selected 12 focus countries (countries receiving the greatest US government investments) and 29 nonfocus countries (controls). We used tuberculosis incidence and mortality rates and relative risks to compare time periods before and after PEPFAR's inception, and a tuberculosis/HIV indicator to calculate the rate of change in tuberculosis incidence relative to the HIV prevalence. Results. Comparing the periods before and after PEPFAR's implementation, both tuberculosis incidence and mortality rates have diminished significantly and to a higher degree in focus countries. The relative risk for developing tuberculosis, comparing those with and without HIV, was 22.5 for control and 20.0 for focus countries. In most focus countries, the tuberculosis epidemic is slowing down despite some regions still experiencing an increase in HIV prevalence. Conclusions. This ecological study showed that PEPFAR had a more consistent and substantial effect on HIV and tuberculosis in focus countries, highlighting the likely link between high levels of HIV investment and broader effects on related diseases such as tuberculosis. © The Author 2013.
acquired immune deficiency syndrome; adult; Africa south of the Sahara; article; Botswana; child; comparative study; controlled study; Cote d'Ivoire; emergency health service; epidemic; Ethiopia; health care planning; human; Human immunodeficiency virus infection; incidence; Kenya; mortality; Mozambique; Namibia; Nigeria; prevalence; priority journal; risk factor; Rwanda; South Africa; Tanzania; tuberculosis; Uganda; United States President Emergency Plan for AIDS Relief; Zambia; Africa south of the Sahara; coepidemic; developing country; epidemic; health; health care policy; Human immunodeficiency virus; international cooperation; microbiology; PEPFAR; Sub-Saharan Africa; United States; virology; Epidemics; HIV Infections; tuberculosis; coepidemic; HIV; incidence; mortality; PEPFAR; sub-Saharan Africa; tuberculosis; Africa South of the Sahara; Developing Countries; Epidemics; Health Policy; HIV Infections; Humans; International Cooperation; Tuberculosis; United States; World Health; Africa South of the Sahara; Developing Countries; Epidemics; Global Health; Health Policy; HIV Infections; Humans; International Cooperation; Tuberculosis; United States