Médecins Sans Frontières (Operational Centre Geneva), Mbabane, Eswatini.
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Trop Med Int Health. 2019 Sep;24(9):1114-1127. doi: 10.1111/tmi.13290. Epub 2019 Aug 7.
This paper assesses patient- and population-level trends in TB notifications during rapid expansion of antiretroviral therapy in Eswatini which has an extremely high incidence of both TB and HIV.
Patient- and population-level predictors and rates of HIV-associated TB were examined in the Shiselweni region in Eswatini from 2009 to 2016. Annual population-level denominators obtained from projected census data and prevalence estimates obtained from population-based surveys were combined with individual-level TB treatment data. Patient- and population-level predictors of HIV-associated TB were assessed with multivariate logistic and multivariate negative binomial regression models.
Of 11 328 TB cases, 71.4% were HIV co-infected and 51.8% were women. TB notifications decreased fivefold between 2009 and 2016, from 1341 to 269 cases per 100 000 person-years. The decline was sixfold in PLHIV vs. threefold in the HIV-negative population. Main patient-level predictors of HIV-associated TB were recurrent TB treatment (adjusted odds ratio [aOR] 1.40, 95% confidence interval [CI]: 1.19-1.65), negative (aOR 1.31, 1.15-1.49) and missing (aOR 1.30, 1.11-1.53) bacteriological status and diagnosis at secondary healthcare level (aOR 1.18, 1.06-1.33). Compared with 2009, the probability of TB decreased for all years from 2011 (aOR 0.69, 0.58-0.83) to 2016 (aOR 0.54, 0.43-0.69). The most pronounced population-level predictor of TB was HIV-positive status (adjusted incidence risk ratio 19.47, 14.89-25.46).
This high HIV-TB prevalence setting experienced a rapid decline in TB notifications, most pronounced in PLHIV. Achievements in HIV-TB programming were likely contributing factors.
本文评估了斯威士兰在抗逆转录病毒疗法快速扩张期间，结核病报告病例在患者和人群层面的变化趋势，斯威士兰的结核病和艾滋病毒感染率都极高。
本文对斯威士兰希塞尔韦尼地区 2009 年至 2016 年期间的患者和人群水平预测因素以及艾滋病毒相关结核病的发病率进行了研究。从预测人口普查数据中获得的年度人口水平分母和从基于人群的调查中获得的流行率估计值与个体层面的结核病治疗数据相结合。利用多变量逻辑回归和多变量负二项回归模型评估了与艾滋病毒相关结核病相关的患者和人群水平预测因素。
在 11 328 例结核病病例中，71.4%为艾滋病毒合并感染，51.8%为女性。2009 年至 2016 年间，结核病报告病例减少了五倍，从每 100 000 人年 1341 例降至 269 例。艾滋病毒感染者中的下降幅度为六倍，而艾滋病毒阴性人群中的下降幅度为三倍。与艾滋病毒相关结核病的主要患者水平预测因素包括复治结核病（调整后的优势比 [aOR] 1.40，95%置信区间 [CI]：1.19-1.65）、阴性（aOR 1.31，1.15-1.49）和缺失（aOR 1.30，1.11-1.53）细菌学状态以及二级保健水平诊断（aOR 1.18，1.06-1.33）。与 2009 年相比，2011 年（aOR 0.69，0.58-0.83）至 2016 年（aOR 0.54，0.43-0.69），所有年份发生结核病的概率均降低。人群层面结核病最显著的预测因素是艾滋病毒阳性状态（调整后的发病率风险比 19.47，14.89-25.46）。
在这个艾滋病毒-结核病高流行地区，结核病报告病例迅速减少，艾滋病毒感染者的减少幅度最为显著。艾滋病毒-结核病规划取得的成就可能是促成因素。
