Skip to main content
Home / The International Journal of Tuberculosis and Lung Disease, Volume 15, Number 7

Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi

Buy Article:

$34.78 + tax (Refund Policy)

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.

Keywords: ART; Malawi; TB; case notification; scale-up

Document Type: Regular Paper

Affiliations: 1: Médecins Sans Frontières (MSF), Medical Department (Operational Research), MSF-Luxembourg, Brussels Operational Centre, Luxembourg 2: Médecins Sans Frontières, Thyolo District, Thyolo, Malawi 3: National TB Control Programme, District Health Services, Ministry of Health and Population, Thyolo District, Malawi 4: Analysis and Advocacy Unit, Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium 5: Regional TB Office and Central Monitoring and Evaluation Unit, Ministry of Health, Lilongwe, Malawi 6: National TB Control Programme, Ministry of Health, Lilongwe, Malawi 7: International Union Against Tuberculosis and Lung Disease, Paris, France; and London School of Hygiene & Tropical Medicine, London, UK

Publication date: 01 July 2011

More about this publication?

  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

  • Editorial Board
  • Information for Authors
  • Subscribe to this Title
  • International Journal of Tuberculosis and Lung Disease
  • Public Health Action
  • Ingenta Connect is not responsible for the content or availability of external websites

Share Content

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content