Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa : analysis of cohort studies at antiretroviral treatment programmes

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dc.contributor.authorBallif, Marieen_ZA
dc.contributor.authorZurcher, Kathrinen_ZA
dc.contributor.authorReid, Stewart E.en_ZA
dc.contributor.authorBoulle, Andrewen_ZA
dc.contributor.authorFox, Matthew P.en_ZA
dc.contributor.authorProzesky, Hans W.en_ZA
dc.contributor.authorChimbetete, Cleophasen_ZA
dc.contributor.authorZwahlen, Marcelen_ZA
dc.contributor.authorEgger, Matthiasen_ZA
dc.contributor.authorFenner, Lukasen_ZA
dc.date.accessioned2019-10-22T12:53:54Z
dc.date.available2019-10-22T12:53:54Z
dc.date.issued2018-01
dc.descriptionCITATION: Ballif, M. et al. 2018. Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes. BMJ Open 8(1):e017405, doi:10.1136/bmjopen-2017-017405.en_ZA
dc.descriptionThe original publication is available at https://bmjopen.bmj.com/en_ZA
dc.description.abstractObjectives Seasonal variations in tuberculosis diagnoses have been attributed to seasonal climatic changes and indoor crowding during colder winter months. We investigated trends in pulmonary tuberculosis (PTB) diagnosis at antiretroviral therapy (ART) programmes in Southern Africa. Setting Five ART programmes participating in the International Epidemiology Database to Evaluate AIDS in South Africa, Zambia and Zimbabwe. Participants We analysed data of 331 634 HIV-positive adults (>15 years), who initiated ART between January 2004 and December 2014. Primary outcome measure We calculated aggregated averages in monthly counts of PTB diagnoses and ART initiations. To account for time trends, we compared deviations of monthly event counts to yearly averages, and calculated correlation coefficients. We used multivariable regressions to assess associations between deviations of monthly ART initiation and PTB diagnosis counts from yearly averages, adjusted for monthly air temperatures and geographical latitude. As controls, we used Kaposi sarcoma and extrapulmonary tuberculosis (EPTB) diagnoses. Results All programmes showed monthly variations in PTB diagnoses that paralleled fluctuations in ART initiations, with recurrent patterns across 2004–2014. The strongest drops in PTB diagnoses occurred in December, followed by April–May in Zimbabwe and South Africa. This corresponded to holiday seasons, when clinical activities are reduced. We observed little monthly variation in ART initiations and PTB diagnoses in Zambia. Correlation coefficients supported parallel trends in ART initiations and PTB diagnoses (correlation coefficient: 0.28, 95% CI 0.21 to 0.35, P<0.001). Monthly temperatures and latitude did not substantially change regression coefficients between ART initiations and PTB diagnoses. Trends in Kaposi sarcoma and EPTB diagnoses similarly followed changes in ART initiations throughout the year. Conclusions Monthly variations in PTB diagnosis at ART programmes in Southern Africa likely occurred regardless of seasonal variations in temperatures or latitude and reflected fluctuations in clinical activities and changes in health-seeking behaviour throughout the year, rather than climatic factors.en_ZA
dc.description.sponsorshipNational Institute Of Allergy And Infectious Diseases of the National Institutes of Health under Award Number U01AI069924en_ZA
dc.description.sponsorshipUnited States Agency for International Development USAID 674-A-12-00029en_ZA
dc.description.sponsorshipSwiss National Science Foundation (Grant No. 174281)en_ZA
dc.description.versionPublishers versionen_ZA
dc.identifier.citationBallif, M. et al. 2018. Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes. BMJ Open 8(1):e017405, doi:10.1136/bmjopen-2017-017405.en_ZA
dc.identifier.issn2044-6055 (online)
dc.identifier.otherdoi:10.1136/bmjopen-2017-017405
dc.identifier.urihttp://hdl.handle.net/10019.1/106696
dc.language.isoen_ZAen_ZA
dc.publisherBMJ Publishing Groupen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectTBen_ZA
dc.subjectTuberculosisen_ZA
dc.subjectPulmonary tuberculosis -- PTBen_ZA
dc.subjectAntiretroviral therapy programmesen_ZA
dc.subjectAntiretroviral therapy-- ARTen_ZA
dc.subjectAIDSen_ZA
dc.subjectHIVen_ZA
dc.subjectSouth Africaen_ZA
dc.subjectZambiaen_ZA
dc.subjectZimbabween_ZA
dc.titleSeasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa : analysis of cohort studies at antiretroviral treatment programmesen_ZA
dc.typeArticleen_ZA
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