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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of the antiretroviral treatment program on the burden of hospitalization for culture-confirmed tuberculosis in South African children: A time-series analysis
Pediatric Infectious Disease Journal, Volume 32, No. 9, Year 2013
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Description
Background: The HIV epidemic increased the burden of tuberculosis (TB) in sub-Saharan Africa. We evaluated the impact that scaling-up of the public-funded antiretroviral treatment (ART) program had on incidence of hospitalization for culture-confirmed and overall-TB in HIV-infected and HIV-uninfected children from 2005 to 2009. Methods: The study was undertaken in Soweto, South Africa, where ART coverage of HIV-infected children increased from 43% in 2005 to 84% by 2009. Trends in incidence of hospitalization for clinically diagnosed and culture-confirmed TB in children 3 months to <15 years of age, identified through laboratory and electronic databases, were analyzed by comparing crude incidence and regression analysis. Results: The incidence (per 100,000) of culture-confirmed TB declined by 63.1% from 2005 (69.8) compared with 2009 (25.8; P < 0.0001). This included a 70.6% reduction between 2005 and 2009 among HIV-infected children (incidence: 1566.3 versus 460.7, respectively; P < 0.0001) and 41.3% decrease in HIV-uninfected children (18.7 versus 11.0, respectively; P = 0.0003). The month-by-month rate of decline of culture-confirmed TB was 2.3% in HIV-infected and 1.1% in HIV-uninfected children over the study period. The residual burden of TB remained 42-fold greater in HIV-infected children, 78% of whom were severely immune compromised, compared with HIV-uninfected children by 2009. Conclusion: Increase in ART coverage was associated with significant decline in TB hospitalizations in HIV-infected children. This reduction may also in part have been due to reduced Mycobacterium tuberculosis transmission resulting from increased ART access among HIV-infected adults, which may have contributed to the reduction of culture-confirmed TB in HIV-uninfected children. © 2013 Lippincott Williams & Wilkins.
Authors & Co-Authors
Dangor, Ziyaad
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Izu, Alane
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Hillier, Kelty
Canada, Hamilton
City of Hamilton Public Health Services
Solomon, Fatima
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Beylis, Natalie C.
South Africa, Johannesburg
National Health Laboratory Service
Moore, David Paul
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Nunes, Marta C.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Madhi, Shabir A.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
South Africa, Johannesburg
National Institute for Communicable Diseases
Statistics
Citations: 26
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1097/INF.0b013e31828d9aa4
ISSN:
08913668
e-ISSN:
15320987
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
South Africa