OBJECTIVES:Antiretroviral 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. DESIGN:Ecological study using aggregate national data. SETTING:Annual 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. RESULTS:ART 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). CONCLUSIONS:This 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.

译文

目的:已知在艾滋病毒感染者(PLHIV)个体中,抗逆转录病毒疗法(ART)和异烟肼预防疗法(IPT)对个体具有结核病(TB)保护作用。在津巴布韦,结核病是由HIV感染引起的,我们评估了2000年至2018年IPT和ART扩大与每年结核病病例通报率(CNR)之间是否存在人群水平的关联。
设计:使用全国汇总数据进行的生态研究。
单位:关于结核病病例报告率(按结核病类别和疾病类型分层),ART护理中PLHIV的数量(和比例)的年度国家汇总数据,其中IPT上已经开始。
结果:到2018年12月,公共部门的ART覆盖率从2004年的<1%(8400 PLHIV)增至约88%(> 110万PLHIV患者),而ARTT护理中的PLHIV中IPT覆盖率从<1%(98 PLHIV)增加),到2012年下降到33%(373917艾滋病毒/艾滋病),到2018年12月。这些与艾滋病有关的干预措施与结核病CNR的显着下降有关:介于全国范围内推广使用抗逆转录病毒疗法之前的最高CNR(2004年)至记录的最低水平从2012年开始实施全国IPT后的CNR,(1)所有结核病病例(510至173例/ 10万人口;下降66%,p <0.001); (2)患有新结核病的患者(501到159例/ 10万人口;下降68%,p <0.001),以及(3)患有临床新诊断为PTB的患者(284到63例/100.000人口;下降77.8% ,p <0.001)。
结论:这项研究表明,在艾滋病毒感染者中继续扩大抗病毒治疗以及在全国范围内开展抗病毒治疗的人群中,IPT的推广对减少结核病,特别是与艾滋病毒相关的临床诊断结核病,具有人口规模的影响。随着ART尤其是IPT覆盖率仍然较低的覆盖面的扩大,还有进一步减少结核病的机会。

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