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

<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 expectan...

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Autores principales:	Peter J Dodd, Gwenan M Knight, Stephen D Lawn, Elizabeth L Corbett, Richard G White
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b6566b53549a498abc620cba2e3b1e86
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spelling	oai:doaj.org-article:b6566b53549a498abc620cba2e3b1e862021-11-18T08:54:51ZPredicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.1932-620310.1371/journal.pone.0075466https://doaj.org/article/b6566b53549a498abc620cba2e3b1e862013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24069418/?tool=EBIhttps://doaj.org/toc/1932-6203<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 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.<h4>Conclusions</h4>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.Peter J DoddGwenan M KnightStephen D LawnElizabeth L CorbettRichard G WhitePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 9, p e75466 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Peter J Dodd Gwenan M Knight Stephen D Lawn Elizabeth L Corbett Richard G White Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
description	<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 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.<h4>Conclusions</h4>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.
format	article
author	Peter J Dodd Gwenan M Knight Stephen D Lawn Elizabeth L Corbett Richard G White
author_facet	Peter J Dodd Gwenan M Knight Stephen D Lawn Elizabeth L Corbett Richard G White
author_sort	Peter J Dodd
title	Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
title_short	Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
title_full	Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
title_fullStr	Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
title_full_unstemmed	Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
title_sort	predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/b6566b53549a498abc620cba2e3b1e86
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Predicting the long-term impact of antiretroviral therapy scale-up on population incidence of tuberculosis.

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