TUBERCULOSIS IN SUB-SAHARAN AFRICA - A REGIONAL ASSESSMENT OF THE IMPACT OF THE HUMAN-IMMUNODEFICIENCY-VIRUS AND NATIONAL TUBERCULOSIS-CONTROL PROGRAM QUALITY
Mf. Cantwell et Nj. Binkin, TUBERCULOSIS IN SUB-SAHARAN AFRICA - A REGIONAL ASSESSMENT OF THE IMPACT OF THE HUMAN-IMMUNODEFICIENCY-VIRUS AND NATIONAL TUBERCULOSIS-CONTROL PROGRAM QUALITY, Tubercle and lung disease, 77(3), 1996, pp. 220-225
Background: The effect of the human immunodeficiency virus (HIV) epide
mic on tuberculosis (TB) has been evaluated for certain countries in s
ub-Saharan Africa. However, no multi-country comparisons have been per
formed of the magnitude of the changes in TB case rates and the roles
of the HIV epidemic and national TB control program (NTP) quality in t
hese changes. Methods: We examined trends in TB case rates after 1985
for 20 sub-Saharan African countries, and also from 1975-1984 for 10 o
f these countries (core countries). Average annual changes in TB case
rates after 1985 were stratified by 1992 urban low-risk HN seroprevale
nce and by NTP quality, as determined by a survey of international TB
experts. Results: Case rates in the core countries decreased by an ave
rage of -1.6% per year prier to 1985, but increased by an average of 7.0% per year after 1985 (+7.7% per year after 1985 in all 20 countrie
s). Average annual case rates after 1985 increased approximately twice
as fast in countries with high vs low or intermediate HIV seroprevale
nce ratings. In both the core countries and all 20 countries, the aver
age annual rate of rise in case rates after 1985 decreased as NTP qual
ity rating increased. This relationship persisted even after stratific
ation by HN seroprevalence rating. Conclusions: TB case rates have inc
reased in sub-Saharan Africa since 1985. These increases were relative
ly greater as HIV seroprevalence increased, and relatively lower as NT
P quality increased. Improving NTP quality is essential to mitigate th
e resurgence of TB in the HIV era.