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Despite antiretroviral therapy (ART) rollout, most cases of tuberculosis among people with HIV in Adama, Ethiopia, occur before ART initiation

Bristedt, Patrik ; Fentie, Meseker ; Björkman, Per LU orcid and Reepalu, Anton LU orcid (2024) In Global Health Action 17(1).
Abstract

Introduction: Although antiretroviral therapy (ART) leads to reduced tuberculosis (TB) incidence in people with HIV (PWH), ART recipients remain at higher risk of TB compared to HIV-seronegative people. With accelerated ART rollout in sub-Saharan Africa, increasing proportions of TB cases among PWH in people receiving long-term ART have been reported. Objective: To determine TB notifications among PWH by ART status in a mainly urban uptake area in Ethiopia during an 8-year period in connection to the introduction of the ‘test-and-treat’ strategy for HIV. Methods: PWH were identified from registers at health facilities providing ART in Adama and surrounding areas, Ethiopia 2015–2022. Annual TB notifications were compared over time. PWH... (More)

Introduction: Although antiretroviral therapy (ART) leads to reduced tuberculosis (TB) incidence in people with HIV (PWH), ART recipients remain at higher risk of TB compared to HIV-seronegative people. With accelerated ART rollout in sub-Saharan Africa, increasing proportions of TB cases among PWH in people receiving long-term ART have been reported. Objective: To determine TB notifications among PWH by ART status in a mainly urban uptake area in Ethiopia during an 8-year period in connection to the introduction of the ‘test-and-treat’ strategy for HIV. Methods: PWH were identified from registers at health facilities providing ART in Adama and surrounding areas, Ethiopia 2015–2022. Annual TB notifications were compared over time. PWH within TB were categorized by ART status at the time of TB diagnosis (pre-ART TB: TB diagnosed before or ≤6 months after starting ART; ART-associated TB: TB diagnosed >6 months after starting ART). Results: Among a total of 8,926 PWH, 993 had been diagnosed with TB (11.1%); mean age 40.0 years [SD 11.8], 53.5% were men). Throughout the study period, most TB cases had been notified before ART initiation (617/993; 62.1%). ART-associated TB cases constituted a mean of 37.4% (range 23.8%–44.2%) of all TB cases among PWH annually. Median time from ART initiation to TB diagnosis among ART-associated TB was 6.0 years. Conclusion: TB notifications among PWH in this area did not decrease 2015–2022, implying persistently high risk of TB among PWH in this setting. Most TB cases occurred in ART-naïve persons, illustrating late HIV diagnosis in this population.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antiretroviral treatment, Ethiopia, HIV, notifications, Tuberculosis
in
Global Health Action
volume
17
issue
1
article number
2395073
publisher
Co-Action Publishing
external identifiers
  • scopus:85202770328
  • pmid:39193669
ISSN
1654-9716
DOI
10.1080/16549716.2024.2395073
language
English
LU publication?
yes
id
ea66cd83-bf25-4fe9-9a2f-f43288548adc
date added to LUP
2024-12-16 10:15:23
date last changed
2025-01-13 12:09:43
@article{ea66cd83-bf25-4fe9-9a2f-f43288548adc,
  abstract     = {{<p>Introduction: Although antiretroviral therapy (ART) leads to reduced tuberculosis (TB) incidence in people with HIV (PWH), ART recipients remain at higher risk of TB compared to HIV-seronegative people. With accelerated ART rollout in sub-Saharan Africa, increasing proportions of TB cases among PWH in people receiving long-term ART have been reported. Objective: To determine TB notifications among PWH by ART status in a mainly urban uptake area in Ethiopia during an 8-year period in connection to the introduction of the ‘test-and-treat’ strategy for HIV. Methods: PWH were identified from registers at health facilities providing ART in Adama and surrounding areas, Ethiopia 2015–2022. Annual TB notifications were compared over time. PWH within TB were categorized by ART status at the time of TB diagnosis (pre-ART TB: TB diagnosed before or ≤6 months after starting ART; ART-associated TB: TB diagnosed &gt;6 months after starting ART). Results: Among a total of 8,926 PWH, 993 had been diagnosed with TB (11.1%); mean age 40.0 years [SD 11.8], 53.5% were men). Throughout the study period, most TB cases had been notified before ART initiation (617/993; 62.1%). ART-associated TB cases constituted a mean of 37.4% (range 23.8%–44.2%) of all TB cases among PWH annually. Median time from ART initiation to TB diagnosis among ART-associated TB was 6.0 years. Conclusion: TB notifications among PWH in this area did not decrease 2015–2022, implying persistently high risk of TB among PWH in this setting. Most TB cases occurred in ART-naïve persons, illustrating late HIV diagnosis in this population.</p>}},
  author       = {{Bristedt, Patrik and Fentie, Meseker and Björkman, Per and Reepalu, Anton}},
  issn         = {{1654-9716}},
  keywords     = {{antiretroviral treatment; Ethiopia; HIV; notifications; Tuberculosis}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Co-Action Publishing}},
  series       = {{Global Health Action}},
  title        = {{Despite antiretroviral therapy (ART) rollout, most cases of tuberculosis among people with HIV in Adama, Ethiopia, occur before ART initiation}},
  url          = {{http://dx.doi.org/10.1080/16549716.2024.2395073}},
  doi          = {{10.1080/16549716.2024.2395073}},
  volume       = {{17}},
  year         = {{2024}},
}