High tuberculosis burden among people living with HIV in southern Mozambique

ABSTRACT

Tuberculosis (TB) remains an important public health concern, and a leading cause of disease and death worldwide. Mozambique is one of the few high TB burden countries where TB figures have not improved in recent years, with an estimated TB incidence in 2013 of 552 cases per 100 000 population [1]. With 58% of all notified TB cases being HIV-positive, Mozambique also has one of the highest TB/HIV co-infection rates. Published data on the burden of TB or HIV disease in the country are scarce, and improving epidemiological surveillance has been identified as an urgent step to improve TB control [2]. People living with HIV (PLHIV) are at a higher risk of developing active TB, which is the main cause of death among this population, accounting for 26% of AIDS-related deaths [3, 4]. It has been estimated that in the African region, 31% of new TB cases in adults were attributable to HIV infection [5]. Most TB incidence measurements among HIV patients come from HIV cohorts [6, 7], clinical trials or mathematical modelling using various strategies described elsewhere [1]. Very few settings, especially in sub-Saharan Africa, provide population-level estimates of TB risk among PLHIV [8, 9]. We determined the incidence rate of TB among HIV-positive and ­negative individuals during 2011 in a high HIV burden setting in southern Mozambique. The study was conducted at the Manhiça Health Research Centre (CISM), located in the rural district of Manhiça, southern Mozambique [10]. This retrospective, population-based epidemiological analysis used three data sources TB notification data were obtained from the 2011 registries of the National TB Control Program for the District of Manhiça, based on passive surveillance; the population at risk was calculated from the latest official census data (2007) for the District of Manhiça, obtained through the Mozambican National Statistics Institute, and the estimated population growth for 2007­2011, using annual data from CISM's Demographic Surveillance System; and HIV prevalence in the district population was estimated using community-based HIV seroprevalence data from a survey conducted in 2010 [11], which only included adults aged 18­47 years...