Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi

Zachariah, R; Bemelmans, M; Akesson, A; Gomani, P; Phiri, K; Isake, B; van Den Akker, T; Philips, M; Mwale, A; Gausi, F; Kwanjana, J; Harries, AD; (2011) Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi. The international journal of tuberculosis and lung disease, 15 (7). pp. 933-937. ISSN 1027-3719 DOI:

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OBJECTIVE: To report on the trends in new and recurrent tuberculosis (TB) case notifications in a rural district of Malawi that has embarked on large-scale roll-out of antiretroviral treatment (ART). METHODS: Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009. RESULTS: There were a total of 10070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifications in the first years after starting ART (2002-2005) was followed by a highly significant and sustained decline from 259 to 173 TB cases per 100000 population (chi(2) for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a significant drop, from 20 to 15 cases/100000 (chi(2) for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases. CONCLUSIONS: High ART implementation coverage is associated with a very significant declining trend in new and recurrent TB case notifications at population level.

Item Type: Article
Keywords: ART, TB, scale-up, case notification, Malawi, epidemic, cohort, hiv-1
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 21682967
Web of Science ID: 292234000013


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