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

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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 10 070 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 100 000 population (χ2 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/100 000 (χ2 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.

Keywords: ART; Malawi; TB; case notification; scale-up

Document Type: Regular Paper


Affiliations: 1: Médecins Sans Frontières (MSF), Medical Department (Operational Research), MSF-Luxembourg, Brussels Operational Centre, Luxembourg 2: Médecins Sans Frontières, Thyolo District, Thyolo, Malawi 3: National TB Control Programme, District Health Services, Ministry of Health and Population, Thyolo District, Malawi 4: Analysis and Advocacy Unit, Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium 5: Regional TB Office and Central Monitoring and Evaluation Unit, Ministry of Health, Lilongwe, Malawi 6: National TB Control Programme, Ministry of Health, Lilongwe, Malawi 7: International Union Against Tuberculosis and Lung Disease, Paris, France; and London School of Hygiene & Tropical Medicine, London, UK

Publication date: 2011-07-01

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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