Abstract
OBJECTIVE
To report on the trends in new and recurrent tuberculosis (TB) case notifications in a rural district of Malawi that has embarked on large-scale roll-out of antiretroviral treatment (ART).
METHODS
Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009.
RESULTS
There were a total of 10 070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifications in the first years after starting ART (2002–2005) was followed by a highly significant and sustained decline from 259 to 173 TB cases per 100 000 population (χ2 for trend 261, P < 0.001, cumulative reduction for 2005–2009 = 33%, 95%CI 27–39). For recurrent TB, the initial increase was followed by a significant drop, from 20 to 15 cases/100 000 (χ2 for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9–49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847–1480) new TB cases and 78 (95%CI 23–151) recurrent TB cases.
CONCLUSIONS
High ART implementation coverage is associated with a very significant declining trend in new and recurrent TB case notifications at population level.
