Tuberculosis among Children and Adolescents at HIV Treatment Centers in Sub-Saharan Africa
oleh: Anna M. Mandalakas, Alexander W. Kay, Jason M. Bacha, Tara Devezin, Rachel Golin, Katherine R. Simon, Dilsher Dhillon, Sandile Dlamini, Andrew DiNardo, Mogo Matshaba, Jill Sanders, Lineo Thahane, Pauline M. Amuge, Saeed Ahmed, Moorine P. Sekadde, Neway G. Fida, Bhekumusa Lukhele, Nodumo Chidah, David Damba, Joseph Mhango, Moses Chodota, Makhorong Matsoso, Angelina Kayabu, Richard S. Wanless, Gordon E. Schutze
| Format: | Article |
|---|---|
| Diterbitkan: | Centers for Disease Control and Prevention 2020-12-01 |
Deskripsi
HIV-infected children and adolescents are at increased risk for tuberculosis (TB). Antiretroviral therapy (ART) reduces TB risk in HIV-infected adults, but its effectiveness in HIV-infected children and adolescents is unknown. We analyzed data from 7 integrated pediatric HIV/TB centers in 6 countries in sub-Saharan Africa. We used a Bayesian mixed-effect model to assess association between ART and TB prevalence and used adaptive lasso regression to analyze risk factors for adverse TB outcomes. The study period encompassed 57,525 patient-years and 1,160 TB cases (2,017 cases/100,000 patient-years). Every 10% increase in ART uptake resulted in a 2.33% reduction in TB prevalence. Favorable TB outcomes were associated with increased time in care and early ART initiation, whereas severe immunosuppression was associated with death. These findings support integrated HIV/TB services for HIV-infected children and adults and demonstrate the association of ART uptake with decreased TB incidence in high HIV/TB settings.