Declining Tuberculosis Incidence among People Receiving HIV Care and Treatment Services in East Africa, 2007-2012.

BACKGROUND: Antiretroviral therapy (ART) reduces the risk of 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.

METHODS: 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 (IeDEA). Temporal trends in facility-based annual TB incidence rates (per 100,000 person-years (PYs)) among PLWH and country-specific standardized TB incidence ratios (SIRs) using annual population-level TB incidence data from the World Health Organization (WHO) were computed between 2007 and 2012. We examined patient- and facility-level factors associated with incident TB using multivariable Cox models.

RESULTS: Overall, TB incidence rates among PLWH in care declined 5-fold between 2007 and 2012 from 5,960 to 985 per 100,000 PYs [p=0.0003] (Kenya: 7,552 to 1,115 [p=0.0007]; Tanzania: 7,153 to 635 [p=0.0025]; Uganda: 3,204 to 242 [p=0.018]). SIRs significantly decreased in the three 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 IPT and receiving care in facilities offering TB treatment on-site.

CONCLUSIONS: Annual TB incidence rates among PLWH significantly declined during ART scale-up but remained higher than the general population. Increasing access to ART and IPT and co-location of HIV and TB treatment may further reduce TB incidence among PLWH.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.