Médecins Sans Frontières (MSF), Medical Department (Operational Research), MSF-Luxembourg, Brussels Operational Centre, Luxembourg.
Int J Tuberc Lung Dis. 2011 Jul;15(7):933-7. doi: 10.5588/ijtld.10.0666.
To report on the trends in new and recurrent tuberculosis (TB) case notifications in a rural district of Malawi that has embarked on large-scale roll-out of antiretroviral treatment (ART).
Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009.
There were a total of 10,070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifications in the first years after starting ART (2002-2005) was followed by a highly significant and sustained decline from 259 to 173 TB cases per 100,000 population (χ(2) for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a significant drop, from 20 to 15 cases/100,000 (χ(2) for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases.
High ART implementation coverage is associated with a very significant declining trend in new and recurrent TB case notifications at population level.
报告在马拉维一个农村地区开展大规模抗逆转录病毒治疗（ART）以来，新发病例和复发病例的结核病（TB）报告趋势。
对 2002 年至 2009 年期间的结核病病例报告和 ART 登记数据进行描述性研究。
共有 10070 例新发和 755 例复发病例。ART 推广始于 2003 年，到 2007 年，估计有 80%的 ART 覆盖率，并在此后保持稳定。对于新发病例，在开始 ART 的最初几年中，病例报告数量有所增加（2002-2005 年），随后呈现出显著且持续下降趋势，从每 10 万人中 259 例降至 173 例（趋势检验 χ(2)261，P<0.001，2005-2009 年累计减少 33%，95%CI 27-39）。对于复发病例，最初增加后显著下降，从每 10 万人 20 例降至 15 例（线性趋势检验 χ(2)8.3，P=0.004，2006 年至 2009 年累计减少 25%，95%CI 9-49）。从 2005 年至 2009 年，ART 避免了约 1164 例（95%CI 847-1480）新发病例和 78 例（95%CI 23-151）复发病例。
高覆盖率的 ART 实施与人群中新发病例和复发病例结核病报告的显著下降趋势相关。
