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Open Access Scale-up of ART in Malawi has reduced case notification rates in HIV-positive and HIV-negative tuberculosis

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Setting: For 30 years, Malawi has experienced a dual epidemic of human immunodeficiency virus (HIV) infection and tuberculosis (TB) that has recently begun to be attenuated by the scale-up of antiretroviral therapy (ART).

Objective: To report on the correlation between ART scale-up and annual national TB case notification rates (CNR) in Malawi, stratified by HIV-positive and HIV-negative status, from 2005 to 2015.

Design: A retrospective descriptive ecological study using aggregate data from national reports.

Results: From 2005 to 2015, ART was scaled up in Malawi from 28 470 to 618 488 total patients, with population coverage increasing from 2.4% to 52.2%. During this time, annual TB notifications declined by 35%, from 26 344 to 17 104, and the TB CNR per 100 000 population declined by 49%, from 206 to 105. HIV testing uptake increased from 51% to 92%. In known HIV-positive TB patients, the CNR decreased from a high of 1247/100 000 to 710/100 000, a 43% decrease. In known HIV-negative TB patients, the CNR also decreased, from a high of 66/100 000 to 49/100 000, a 26% decrease.

Conclusion: TB case notifications have continued to decline in association with ART scale-up, with the decline seen more in HIV-positive than HIV-negative TB. These findings have programmatic implications for national TB control efforts.
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Keywords: HIV/AIDS; Malawi; TB; antiretroviral therapy; human immunodeficiency virus

Document Type: Research Article

Affiliations: 1: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi 2: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi, International Training and Education Center for Health (I-TECH) Malawi, Department of Global Health, University of Washington, Seattle, Washington, USA 3: Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Luxembourg City, Luxembourg 4: International Union Against Tuberculosis and Lung Disease, Paris, France, London School of Hygiene & Tropical Medicine, London, UK 5: International Training and Education Center for Health (I-TECH) Malawi, Department of Global Health, University of Washington, Seattle, Washington, USA, Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi 6: Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi

Publication date: December 21, 2016

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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