Trends in prevalent TB among persons enrolling for HIV care before and after 'Test and Treat' across East-Africa.

IJTLD open Pub Date : 2025-06-13 eCollection Date: 2025-06-01 DOI:10.5588/ijtldopen.24.0687

N Kalema, B Musick, S Babirye, L Najjemba, P Mubiri, A Kiragga, A Ddungu, C Kasozi, L O Diero, F Odhiambo, R Lyamuya, B Castelnuovo, J Musaazi, C T Yiannoutsos, K Wools-Kaloustian, A Semeere

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Abstract

Background: In 2015, WHO recommended the global adoption of the 'Test and Treat' strategy (TTS) for all persons living with HIV (PLHIV). While TTS has improved viral suppression and reduced mortality, its impact on TB in PLHIV remains unclear.

Methods: We assessed TB prevalence trends 48 months before and after TTS among PLHIV aged ≥18 years enrolling at HIV primary care sites affiliated with the East Africa International Epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium. We defined prevalent TB as bacteriologically confirmed or empirically treated TB within 60 days of enrolment. We estimated monthly TB prevalence trends using Poisson (change point) model.

Results: Among 125,647 PLHIV, 37% were male. The prevalence of TB was 8.9% (95% CI: 8.7-9.1) before and 6.2% (95% CI: 5.9-6.4) after TTS-adoption. Adjusted analysis showed significant downward trend in TB prevalence before TTS (adjusted Prevalence Rate Ratio, aPRR=0.989, p<0.001), which plateaued during TTS (aPRR=0.999, p=0.131). TB was more frequently present among males (aPRR: 2.09, p<0.001) and adults ≥25 years across both periods.

Conclusion: This study highlights a plateau in TB prevalence decline during TTS and persistent disparities in TB by sex and age, underscoring the need for targeted interventions.

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东非各国在“检测和治疗”前后参加艾滋病毒护理的人群中结核病流行趋势。

背景：2015年，世卫组织建议全球对所有艾滋病毒感染者采用“检测和治疗”战略。虽然TTS改善了病毒抑制并降低了死亡率，但其对PLHIV患者结核病的影响仍不清楚。方法：我们在隶属于东非国际流行病学数据库评估艾滋病（EA-IeDEA）联盟的HIV初级保健站点，评估了TTS前后48个月年龄≥18岁的PLHIV患者的结核病流行趋势。我们将流行结核病定义为入组后60天内细菌学确诊或经验性治疗的结核病。我们使用泊松（泊松变化点）模型估计每月结核病流行趋势。结果：125647例hiv感染者中，男性占37%。采用tts前结核病患病率为8.9% (95% CI: 8.7-9.1)，采用tts后为6.2% （95% CI: 5.9-6.4）。调整后的分析显示，TTS前结核病患病率呈显著下降趋势（调整后的患病率比，aPRR=0.989, p）。结论：本研究强调了TTS期间结核病患病率下降的平台性，以及结核病在性别和年龄方面的持续差异，强调了有针对性干预的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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IJTLD open

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