Countrywide management of pulmonary tuberculosis reverses increasing incidence
DESIGN: Retrospective analysis of notification rates and treatment outcomes of PTB and MDR-TB during 1998–2006.
RESULTS: The annual notification rates of both PTB and MDR-TB decreased significantly, by on average 3.3 (P = 0.007) and 1.7 (P = 0.008) cases per 100 000 population, respectively. The accelerating impact of SLD availability on the annual decline was significant for both PTB overall and MDR-TB (P = 0.003 and P = 0.025, respectively). During 1998–2006, an increase in TB-HIV co-infection (P = 0.009) significantly affected the notification rates of both PTB overall and MDR-TB (P < 0.001 and P < 0.001, respectively). The negative impact of TB-HIV co-infection was counterbalanced by the availability of SLDs, the decrease in the MDR-TB rate and the increase in gross domestic product (GDP) per capita, as confirmed by multivariate analysis.
CONCLUSION: Countrywide access to SLDs and the coordinated effect of programmatic conditions can, in parallel with increasing GDP, reverse the increasing notification rates of PTB and MDR-TB in the context of an HIV epidemic.
Document Type: Regular Paper
Affiliations: 1: Lung Clinic, Tartu University Clinics, Tartu, Estonia; Department of Communicable Diseases Prevention and Control, Reykjavik Health Care Services, Reykjavik, Iceland 2: National Institute for Health Development, Estonian Tuberculosis Registry, Tallinn, Estonia 3: Department of Communicable Diseases Prevention and Control, Reykjavik Health Care Services, Reykjavik, Iceland; Landspitali University Hospital, Department of Pulmonology, Reykjavik, Iceland 4: Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia
Publication date: 2011-07-01
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