ArticleJournal of the International AIDS Society2015
Temporal trends in TB notification rates during ART scale-up in Cape Town: an ecological analysis.
Article in Journal of the International AIDS Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 26 citations in OpenAlex.
- Trial
- HIV prevalence and determinants of loss-to-follow-up in adolescents and young adults with tuberculosis in Cape Town.PloS one · 2019Trial
- The role of neighborhood factors in the cumulative number of episodes of recurrent tuberculosis in Cape Town.Journal of clinical tuberculosis and other mycobacterial diseases · 2026Article
- Drivers of sex differences in the South African adult tuberculosis incidence and mortality trends, 1990-2019.Scientific reports · 2023Article
- High Rates of Recurrent Tuberculosis Disease: A Population-level Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Regional changes in tuberculosis disease burden among adolescents in South Africa (2005-2015).PloS one · 2020Article
- Decreased risk of HIV-associated TB during antiretroviral therapy expansion in rural Eswatini from 2009 to 2016: a cohort and population-based analysis.Tropical medicine & international health : TM & IH · 2019Article
- Anti-retroviral therapy scale-up and its impact on sex-stratified tuberculosis notification trends in Uganda.Journal of the International AIDS Society · 2019Article
- Space-time clustering of recently-diagnosed tuberculosis and impact of ART scale-up: Evidence from an HIV hyper-endemic rural South African population.Scientific reports · 2019Article
- The differential impact of HIV and antiretroviral therapy on gender-specific tuberculosis rates.Tropical medicine & international health : TM & IH · 2019Article
- Clinical Development of New TB Vaccines: Recent Advances and Next Steps.Frontiers in microbiology · 2019Review
- Assessing the impact of antiretroviral therapy on tuberculosis notification rates among people with HIV: a descriptive analysis of 23 countries in sub-Saharan Africa, 2010-2015.BMC infectious diseases · 2018Article
- Article
- HIV and TB co-infection in the ART era: CD4 count distributions and TB case fatality in Cape Town.BMC infectious diseases · 2018Article
- Spatial clustering of drug-resistant tuberculosis in Hlabisa subdistrict, KwaZulu-Natal, 2011-2015.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2018Article
- Drivers of Tuberculosis Transmission.The Journal of infectious diseases · 2017Review
- Reduction in extrapulmonary tuberculosis in context of antiretroviral therapy scale-up in rural South Africa.Epidemiology and infection · 2017Article
- The impact of the roll-out of rapid molecular diagnostic testing for tuberculosis on empirical treatment in Cape Town, South Africa.Bulletin of the World Health Organization · 2017Article
- Can antiretrovirals curb southern Africa's HIV-associated TB epidemic?Public health action · 2016Article
- Tuberculosis in Cape Town: An age-structured transmission model.Epidemics · 2016Article
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Authors and funding
5 authors at 4 institutions in 3 countries.
Funding
Abstract
introductionAlthough antiretroviral therapy (ART) reduces individual tuberculosis (TB) risk by two-thirds, the population-level impact remains uncertain. Cape Town reports high TB notification rates associated with endemic HIV. We examined population trends in TB notification rates during a 10-year period of expanding ART.
methodsAnnual Cape Town TB notifications were used as numerators and mid-year Cape Town populations as denominators. HIV-stratified population was calculated using overall HIV prevalence estimates from the Actuarial Society of South Africa AIDS and Demographic model. ART provision numbers from Western Cape government reports were used to calculate overall ART coverage. We calculated rates per 100,000 population over time, overall and stratified by HIV status. Rates per 100,000 total population were also calculated by ART use at treatment initiation. Absolute numbers of notifications were compared by age and sub-district. Changes over time were described related to ART provision in the city as a whole (ART coverage) and by sub-district (numbers on ART).
resultsFrom 2003 to 2013, Cape Town's population grew from 3.1 to 3.7 million inhabitants, and estimated HIV prevalence increased from 3.6 to 5.2%. ART coverage increased from 0 to 63% in 2013. TB notification rates declined by 16% (95% confidence interval (CI), 14-17%) from a 2008 peak (851/100,000) to a 2013 nadir (713/100,000). Decreases were higher among the HIV-positive (21% (95% CI, 19-23%)) than the HIV-negative (9% (95% CI, 7-11%)) population. The number of HIV-positive TB notifications decreased mainly among 0- to 4- and 20- to 34-year-olds. Total population rates on ART at TB treatment initiation increased over time but levelled off in 2013. Overall median CD4 counts increased from 146 cells/µl (interquartile range (IQR), 66, 264) to 178 cells/µl (IQR 75, 330; p<0.001). Sub-district antenatal HIV seroprevalence differed (10-33%) as did numbers on ART (9-29 thousand). Across sub-districts, infant HIV-positive TB decreased consistently whereas adult decreases varied.
conclusionsHIV-positive TB notification rates declined during a period of rapid scale-up of ART. Nevertheless, both HIV-positive and HIV-negative TB notification rates remained very high. Decreases among HIV positives were likely blunted by TB remaining a major entry to the ART programme and occurring after delayed ART initiation.
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