Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin 150081, China; Ghana Health Service, Private Mail Bag, Bolgatanga, Upper East Region, Ghana.
Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin 150081, China; Department of Preventive Medicine, Qiqihar Medical University, Qiqihar 161006, China.
Public Health. 2021 Feb;191:48-54. doi: 10.1016/j.puhe.2020.04.021. Epub 2021 Jan 25.
Antiretroviral therapy (ART) reduces the risk of tuberculosis (TB). We aimed to examine the association between ART coverage scale-up on the changes in TB incidence in Africa from 2000 to 2018.
The design of the study is a retrospective ecological study.
Data for 54 countries were obtained from several institutional-based sources, including the World Health Organization, the Joint United Nations Programme on HIV/AIDS, and the World Bank. A fixed-effects regression method of longitudinal data analysis was used to estimate the association between ART coverage and changes in TB incidence rate during 2000-2018. Statistical analyses were conducted using STATA 15.0/IC.
The TB incidence declined significantly, by an average of 2.3% per year during 2000-2018. The highest significant declines occurred in eastern and southern Africa. In adjusted analysis, each 1% increase in ART coverage was associated with a 3.97 per 100,000 decline of TB incidence. However, the marginal effects of ART on overall population TB incidence was dependent on the prevalence of human immunodeficiency virus infection.
Investment in the widespread scale-up of ART may contribute to the control of the TB epidemic in Africa. However, interventions are also needed to augment the effect of ART on population TB incidence.
抗逆转录病毒疗法（ART）可降低结核病（TB）的风险。本研究旨在探讨 2000 年至 2018 年期间，抗逆转录病毒治疗覆盖率的扩大与非洲结核病发病率变化之间的关系。
本研究为回顾性生态学研究。
从世界卫生组织、联合国艾滋病规划署和世界银行等多个机构来源获得了 54 个国家的数据。采用纵向数据分析的固定效应回归方法来估计 2000-2018 年间抗逆转录病毒治疗覆盖率与结核病发病率变化之间的关联。使用 STATA 15.0/IC 进行统计分析。
2000-2018 年间，结核病发病率呈显著下降趋势，平均每年下降 2.3%。发病率下降最显著的地区是东非和南非。在调整分析中，抗逆转录病毒治疗覆盖率每增加 1%，结核病发病率就会下降 3.97/10 万。然而，抗逆转录病毒治疗对全人群结核病发病率的边际效应取决于人类免疫缺陷病毒感染的流行率。
广泛扩大抗逆转录病毒治疗的投资可能有助于控制非洲的结核病流行。然而，还需要采取干预措施来增强抗逆转录病毒治疗对人群结核病发病率的影响。
