Declining tuberculosis case notification rates with the scale-up of antiretroviral therapy in Zimbabwe

ObjectivesAntiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are known to have a tuberculosis (TB) protective effect at the individual level among people living with HIV (PLHIV). In Zimbabwe where TB is driven by HIV infection, we have assessed whether there is a population-level association between IPT and ART scale-up and annual TB case notification rates (CNRs) from 2000 to 2018.DesignEcological study using aggregate national data.SettingAnnual aggregate national data on TB case notification rates (stratified by TB category and type of disease), numbers (and proportions) of PLHIV in ART care and of these, numbers (and proportions) ever commenced on IPT.ResultsART coverage in the public sector increased from <1% (8400 PLHIV) in 2004 to ~88% (>1.1 million PLHIV patients) by December 2018, while IPT coverage among PLHIV in ART care increased from <1% (98 PLHIV) in 2012 to ~33% (373 917 PLHIV) by December 2018. These HIV-related interventions were associated with significant declines in TB CNRs: between the highest CNR prior to national roll-out of ART (in 2004) to the lowest recorded CNR after national IPT roll-out from 2012, these were (1) for all TB case (510 to 173 cases/100 000 population; 66% decline, p<0.001); (2) for those with new TB (501 to 159 cases/100 000 population; 68% decline, p<0.001) and (3) for those with new clinically diagnosed PTB (284 to 63 cases/100 000 population; 77.8% decline, p<0.001).ConclusionsThis study shows the population-level impact of the continued scale-up of ART among PLHIV and the national roll-out of IPT among those in ART care in reducing TB, particularly clinically diagnosed TB which is largely associated with HIV. There are further opportunities for continued mitigation of TB with increasing coverage of ART and in particular IPT which still has a low coverage.

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The Diagnostic Performance of Chest-X-Ray and Erythrocyte Sedimentation Rate in Comparison with GeneXpert® for Tuberculosis Case Notification Among Patients Living with Human Immunodeficiency Virus in a Resource-Limited Setting: A Cross-Sectional Study

Risk Management and Healthcare Policy ◽

10.2147/rmhp.s264447 ◽

2020 ◽

Vol Volume 13 ◽

pp. 1639-1646

Author(s):

Abebe Sorsa

Keyword(s):

Cross Sectional Study ◽

Tuberculosis Case ◽

Cross Sectional ◽

X Ray ◽

Erythrocyte Sedimentation ◽

Resource Limited ◽

Immunodeficiency Virus ◽

Chest X Ray ◽

Case Notification ◽

Limited Setting

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Community-based model for the delivery of antiretroviral therapy in Cambodia: a quasi-experimental study protocol

BMC Infectious Diseases ◽

10.1186/s12879-021-06414-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sovannary Tuot ◽

Alvin Kuo Jing Teo ◽

Kiesha Prem ◽

Pheak Chhoun ◽

Chamroen Pall ◽

...

Keyword(s):

Experimental Study ◽

Antiretroviral Therapy ◽

Scale Up ◽

Economic Evaluations ◽

People Living With Hiv ◽

Cad Model ◽

Community Based ◽

Quasi Experimental ◽

Living With Hiv ◽

Art Delivery

Abstract Background Multi-month dispensing (MMD) is the mainstay mechanism for clinically stable people living with HIV in Cambodia to refill antiretroviral therapy (ART) every 3-6 months. However, less frequent ART dispensing through the community-based ART delivery (CAD) model could further reduce the clients’ and health facilities’ burden. While community-based services have been recognized as an integral component of HIV response in Cambodia, their role and effectiveness in ART delivery have yet to be systematically assessed. This study aims to evaluate the CAD model’s effectiveness on the continuum of care and treatment outcomes for stable people living with HIV in Cambodia. Methods We will conduct this quasi-experimental study in 20 ART clinics across the capital city and nine provinces between May 2021 and April 2023. Study sites were purposively selected based on the availability of implementing partners, the number of people living with HIV each clinic serves, and the accessibility of the clinics. In the intervention arm, approximately 2000 stable people living with HIV will receive ART and services from the CAD model. Another 2000 stable people living with HIV in the control arm will receive MMD—a standard care model for stable people living with HIV. The primary outcomes will be retention in care, viral load suppression, and adherence to ART. The secondary endpoints will include health providers’ work burden, the model’s cost-effectiveness, quality of life, mental health, social support, stigma, and discrimination. We will compare the outcome indicators within each arm at baseline, midline, and endline using descriptive and inferential statistics. We will evaluate the differences between the intervention and control arms using the difference-in-differences method. We will perform economic evaluations to determine if the intervention is cost-effective. Discussion This study will build the evidence base for future implementation and scale-up of CAD model in Cambodia and other similar settings. Furthermore, it will strengthen engagements with community stakeholders and further improve community mobilization, a vital pillar of the Cambodian HIV response. Trial registration ClinicalTrials.gov, NCT04766710. Registered 23 February 2021, Version 1.

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