If national health programmers and policy makers are looking for reasons to put into practice World Health Organization recommendations that all people with HIV have access to immediate antiretroviral treatment, a study from Zimbabwe supplies one more: As the numbers of people accessing HIV treatment went up in that country, the numbers of reported tuberculosis cases were cut nearly in half.
The study, published this week in Public Health Action, tracked annual data on all people living with HIV and on antiretroviral treatment rolls, as well as data on all reported tuberculosis patients from 2004 to 2013, and reached conclusions echoing findings in other countries where HIV infection has driven tuberculosis epidemics, that expanding antiretroviral treatment coverage reduces the burden of tuberculosis.
In Zimbabwe where an estimated 1.4 million people — about 15 percent of the population — live with HIV, about three out of every four tuberculosis patients are co-infected with HIV, the authors note. Antiretroviral treatment did not become available in public health settings until 2004, when fewer than 1 in every 200 people who needed it received it. By 2014 with all but 11 of the country’s 1560 health facilities offering antiretroviral treatment, and policies on who could receive it making treatment available earlier in the course of infections, 48 percent of people living with HIV eligible for treatment were receiving it. Over those years numbers of reported tuberculosis patients dropped from 450 for every 100,000 people to 250 for every 100,000. The drops in reported cases were interrupted briefly, with slight rises during the country’s financial crisis from 2008 to 2010, when food shortages added to health challenges, particularly those faced by people living with HIV. Tuberculosis cases, however, decreased again in the next couple of years, reaching their lowest rates across the years tracked in 2013.
The authors, led by Kudakwashe Takarinda of the Zimbabwe Ministry of Health, note that their findings add impetus to continued efforts to increase access to antiretroviral treatment. But they also emphasize that antiretroviral treatment access is but one necessary component to controlling HIV in the country. Noting that among people living with HIV in Zimbabwe, even those with immune cell counts higher than that set for antiretroviral treatment eligibility under the nation’s current policies have four times the tuberculosis incidence of people without HIV in Zimbabwe, they recommend that HIV clinics increase access to isoniazid preventive therapy — IPT — against TB.