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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31828d9aa4
HIV Reports

Impact of the Antiretroviral Treatment Program on the Burden of Hospitalization for Culture-confirmed Tuberculosis in South African Children: A Time-series Analysis

Dangor, Ziyaad MBBCh, MMed, FCPaed*; Izu, Alane PhD; Hillier, Kelty MSc; Solomon, Fatima MBBCh; Beylis, Natalie MBBCh, FCPath§; Moore, David P. MBBCh, FCPaed, MPhil; Nunes, Marta C. PhD; Madhi, Shabir A. MBBCh, FCPaed, PhD†¶

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Abstract

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.

Copyright © 2013 by Lippincott Williams & Wilkins

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