TY - JOUR
T1 - The impact of the HIV epidemic on tuberculosis transmission in Tanzania
AU - Egwaga, Saidi M.
AU - Cobelens, Frank G.
AU - Muwinge, Hemed
AU - Verhage, Corry
AU - Kalisvaart, Nico
AU - Borgdorff, Martien W.
PY - 2006
Y1 - 2006
N2 - OBJECTIVE: To assess the impact of the HIV epidemic on tuberculosis transmission in Tanzania by estimating the trend in annual risk of tuberculosis infection (ARTI) over the period 1983-2003. DESIGN: Tuberculin survey among school children aged 6-14 years, randomly selected by cluster sampling. METHODS: Primary outcome was the ARTI among children without a BCG vaccination scar. To obtain time trends, data were reanalysed from three previous surveys carried out at intervals of 5 years since 1983, using identical methods and definitions. RESULTS: Of 96,226 children included in the analysis (74% of those enrolled), 10,239 (11%) had no BCG scar. The ARTI was 0.68% (95% confidence interval 0.55-0.81). Despite a doubling of notification rates of smear-positive tuberculosis since 1983, this represents an average annual decline since the first survey of 2.7% (P < 0.001). The declining trend in ARTI was observed in 17 of 20 regions, with no association between this trend and region-specific prevalence of HIV infection among patients with tuberculosis (P = 0.575). A similar decline in ARTI was observed among children with a BCG scar and for various ways of estimating the prevalence of tuberculosis infection from the distribution of skin test reactions. CONCLUSION: Despite substantial increases in tuberculosis incidence, the overall population-level effect of the HIV epidemic on tuberculosis transmission in Tanzania has been limited. This suggests that in the presence of a strong control programme, the HIV epidemic has limited impact on tuberculosis transmission
AB - OBJECTIVE: To assess the impact of the HIV epidemic on tuberculosis transmission in Tanzania by estimating the trend in annual risk of tuberculosis infection (ARTI) over the period 1983-2003. DESIGN: Tuberculin survey among school children aged 6-14 years, randomly selected by cluster sampling. METHODS: Primary outcome was the ARTI among children without a BCG vaccination scar. To obtain time trends, data were reanalysed from three previous surveys carried out at intervals of 5 years since 1983, using identical methods and definitions. RESULTS: Of 96,226 children included in the analysis (74% of those enrolled), 10,239 (11%) had no BCG scar. The ARTI was 0.68% (95% confidence interval 0.55-0.81). Despite a doubling of notification rates of smear-positive tuberculosis since 1983, this represents an average annual decline since the first survey of 2.7% (P < 0.001). The declining trend in ARTI was observed in 17 of 20 regions, with no association between this trend and region-specific prevalence of HIV infection among patients with tuberculosis (P = 0.575). A similar decline in ARTI was observed among children with a BCG scar and for various ways of estimating the prevalence of tuberculosis infection from the distribution of skin test reactions. CONCLUSION: Despite substantial increases in tuberculosis incidence, the overall population-level effect of the HIV epidemic on tuberculosis transmission in Tanzania has been limited. This suggests that in the presence of a strong control programme, the HIV epidemic has limited impact on tuberculosis transmission
U2 - https://doi.org/10.1097/01.aids.0000218557.44284.83
DO - https://doi.org/10.1097/01.aids.0000218557.44284.83
M3 - Article
C2 - 16549977
SN - 0269-9370
VL - 20
SP - 915
EP - 921
JO - AIDS (London, England)
JF - AIDS (London, England)
IS - 6
ER -