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Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.


ABSTRACT:

Objective

To investigate the impact of antiretroviral therapy (ART) on long-term population-level tuberculosis disease (TB) incidence in sub-Saharan Africa.

Methods

We used a mathematical model to consider the effect of different assumptions about life expectancy and TB risk during long-term ART under alternative scenarios for trends in population HIV incidence and ART coverage.

Results

All the scenarios we explored predicted that the widespread introduction of ART would initially reduce population-level TB incidence. However, many modelled scenarios projected a rebound in population-level TB incidence after around 20 years. This rebound was predicted to exceed the TB incidence present before ART scale-up if decreases in HIV incidence during the same period were not sufficiently rapid or if the protective effect of ART on TB was not sustained. Nevertheless, most scenarios predicted a reduction in the cumulative TB incidence when accompanied by a relative decline in HIV incidence of more than 10% each year.

Conclusions

Despite short-term benefits of ART scale-up on population TB incidence in sub-Saharan Africa, longer-term projections raise the possibility of a rebound in TB incidence. This highlights the importance of sustaining good adherence and immunologic response to ART and, crucially, the need for effective HIV preventive interventions, including early widespread implementation of ART.

SUBMITTER: Dodd PJ 

PROVIDER: S-EPMC3775764 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Publications

Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.

Dodd Peter J PJ   Knight Gwenan M GM   Lawn Stephen D SD   Corbett Elizabeth L EL   White Richard G RG  

PloS one 20130917 9


<h4>Objective</h4>To investigate the impact of antiretroviral therapy (ART) on long-term population-level tuberculosis disease (TB) incidence in sub-Saharan Africa.<h4>Methods</h4>We used a mathematical model to consider the effect of different assumptions about life expectancy and TB risk during long-term ART under alternative scenarios for trends in population HIV incidence and ART coverage.<h4>Results</h4>All the scenarios we explored predicted that the widespread introduction of ART would in  ...[more]

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