Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status

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dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorLawn, Stephen D.en_ZA
dc.contributor.authorCaldwell, Judyen_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorMiddelkoop, Kerenen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.date.accessioned2012-01-18T08:06:18Z
dc.date.available2012-01-18T08:06:18Z
dc.date.issued2011-10-10
dc.descriptionCITATION: Wood, R. et al. 2011. Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status. PLos ONE, 6(10): e25098, doi:10.1371/journal.pone.0025098.
dc.descriptionThe original publication is available at http://journals.plos.org/plosone
dc.description.abstractAim To describe the burden of tuberculosis (TB) in Cape Town by calculating TB incidence rates stratified by age and HIV-status, assessing the contribution of retreatment disease and estimating the cumulative lifetime TB risk in HIV-negative individuals. Methods Details of TB cases were abstracted from the 2009 electronic TB register. Population denominators were estimated from census data and actuarial estimates of HIV prevalence, allowing calculation of age-specific and HIV-stratified TB notification rates. Results The 2009 mid-year population was 3,443,010 (3,241,508 HIV-negative and 201,502 HIV-positive individuals). There were 29,478 newly notified TB cases of which 56% were laboratory confirmed. HIV status was recorded for 87% of cases and of those with known HIV-status 49% were HIV-negative and 51% were positive. Discrete peaks in the incidence of non-HIV-associated TB occurred at three ages: 511/100,000 at 0–4 years of age, 553/100,000 at 20–24 years and 628/100,000 at 45–49 years with 1.5%, 19% and 45% being due to retreatment TB, respectively. Only 15.5% of recurrent cases had a history of TB treatment failure or default. The cumulative lifetime risks in the HIV-negative population of all new TB episodes and new smear-positive TB episodes were 24% and 12%, respectively; the lifetime risk of retreatment disease was 9%. The HIV-positive notification rate was 6,567/100,000 (HIV-associated TB rate ratio = 17). Although retreatment cases comprised 30% of the HIV-associated TB burden, 88% of these patients had no history of prior treatment failure or default. Conclusions The annual burden of TB in this city is huge. TB in the HIV-negative population contributed almost half of the overall disease burden and cumulative lifetime risks were similar to those reported in the pre-chemotherapy era. Retreatment TB contributed significantly to both HIV-associated and non-HIV-associated TB but infrequently followed prior inadequate treatment. This likely reflects ongoing TB transmission to both HIV-negative and positive individuals.
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0025098
dc.description.versionPublisher's version
dc.format.extent9 pages
dc.identifier.citationWood, R. et al. 2011. Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status. PLos ONE, 6(10): e25098, doi:10.1371/journal.pone.0025098.
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0025098
dc.identifier.urihttp://hdl.handle.net/10019.1/18792
dc.language.isoen
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectTuberculosis -- South Africa -- Western Capeen_ZA
dc.subjectHIV infections -- South Africa -- Western Capeen_ZA
dc.titleBurden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-statusen_ZA
dc.typeArticle
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