British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital.
J Infect Dis. 2013 Dec 15;208(12):2075-84. doi: 10.1093/infdis/jit406. Epub 2013 Aug 2.
There are limited data measuring the impact of expanded human immunodeficiency virus (HIV) prevention activities on the tuberculosis epidemic at the country level. Here, we characterized the potential impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) on the tuberculosis epidemic in sub-Saharan Africa.
We selected 12 focus countries (countries receiving the greatest US government investments) and 29 nonfocus countries (controls). We used tuberculosis incidence and mortality rates and relative risks to compare time periods before and after PEPFAR's inception, and a tuberculosis/HIV indicator to calculate the rate of change in tuberculosis incidence relative to the HIV prevalence.
Comparing the periods before and after PEPFAR's implementation, both tuberculosis incidence and mortality rates have diminished significantly and to a higher degree in focus countries. The relative risk for developing tuberculosis, comparing those with and without HIV, was 22.5 for control and 20.0 for focus countries. In most focus countries, the tuberculosis epidemic is slowing down despite some regions still experiencing an increase in HIV prevalence.
This ecological study showed that PEPFAR had a more consistent and substantial effect on HIV and tuberculosis in focus countries, highlighting the likely link between high levels of HIV investment and broader effects on related diseases such as tuberculosis.
目前，关于扩大艾滋病病毒（HIV）预防活动对国家一级结核病流行的影响，相关数据有限。在此，我们描述了美国艾滋病紧急救援计划（PEPFAR）对撒哈拉以南非洲结核病流行的潜在影响。
我们选择了 12 个重点国家（接受美国政府最大投资的国家）和 29 个非重点国家（对照组）。我们使用结核病发病率和死亡率以及相对风险，比较 PEPFAR 启动前后的时间段，并使用结核病/HIV 指标来计算相对于 HIV 流行率的结核病发病率的变化率。
与 PEPFAR 实施前相比，重点国家的结核病发病率和死亡率均显著下降，且降幅更大。在对照组和重点国家中，HIV 阳性和阴性个体发生结核病的相对风险分别为 22.5 和 20.0。在大多数重点国家，尽管某些地区 HIV 流行率仍在上升，但结核病流行速度正在放缓。
这项生态学研究表明，PEPFAR 对重点国家的 HIV 和结核病产生了更一致和更显著的影响，突出表明高水平的 HIV 投资与相关疾病（如结核病）的广泛影响之间可能存在关联。
