Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis

Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 h...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2016-08, Vol.11 (8), p.e0160481-e0160481
Main Authors: Yan, Isabel, Bendavid, Eran, Korenromp, Eline L
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Analysis
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiretroviral Therapy, Highly Active - economics
Antiretroviral Therapy, Highly Active - methods
Biology and Life Sciences
Cotrimoxazole
Death
Drug therapy
Econometrics
Fatalities
Follow-Up Studies
Health aspects
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - drug therapy
HIV Infections - economics
HIV Infections - epidemiology
Human immunodeficiency virus
Humans
Impact analysis
Isoniazid
Lentivirus
Medicine and Health Sciences
Models, Econometric
Mortality
Mycobacterium
People and Places
Prevalence
Prognosis
Regression analysis
Social Sciences
Therapy
Tuberculosis
Tuberculosis - drug therapy
Tuberculosis - economics
Tuberculosis - epidemiology
Tuberculosis - mortality
Urbanization
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries. We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted for annual TB case detection rates, and (2) WHO TB mortality estimates. National coverage with ART, as proportion of HIV-infected people in need, was obtained from UNAIDS. We applied panel linear regressions controlling for HIV prevalence (5-year lagged), coverage of TB interventions (estimated by WHO and UNAIDS), gross domestic product per capita, health spending from domestic sources, urbanization, and country fixed effects. Models suggest that that increasing ART coverage was followed by reduced TB mortality, across multiple specifications. For death notifications at 2 to 5 years following a given ART scale-up, a 1% increase in ART coverage predicted 0.95% faster mortality rate decline (p = 0.002); resulting in 27% fewer TB deaths in 2011 alone than would have occurred without ART. Based on WHO death estimates, a 1% increase in ART predicted a 1.0% reduced TB death rate (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0160481