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 Den_ZA
dc.contributor.authorCaldwell, Judyen_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorMiddelkoop, Kerenen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.date.accessioned2015-11-23T12:25:36Z
dc.date.available2015-11-23T12:25:36Z
dc.date.issued2011en_ZA
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.en_ZA
dc.identifier.apacitationWood, R., Lawn, S. D., Caldwell, J., Kaplan, R., Middelkoop, K., & Bekker, L. (2011). Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status. <i>PLoS One</i>, http://hdl.handle.net/11427/15272en_ZA
dc.identifier.chicagocitationWood, Robin, Stephen D Lawn, Judy Caldwell, Richard Kaplan, Keren Middelkoop, and Linda-Gail Bekker "Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status." <i>PLoS One</i> (2011) http://hdl.handle.net/11427/15272en_ZA
dc.identifier.citationWood, R., Lawn, S. D., Caldwell, J., Kaplan, R., Middelkoop, K., & Bekker, L. G. (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.0025098en_ZA
dc.identifier.ris TY - Journal Article AU - Wood, Robin AU - Lawn, Stephen D AU - Caldwell, Judy AU - Kaplan, Richard AU - Middelkoop, Keren AU - Bekker, Linda-Gail AB - Aim: 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. DA - 2011 DB - OpenUCT DO - 10.1371/journal.pone.0025098 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status TI - Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status UR - http://hdl.handle.net/11427/15272 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15272
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0025098
dc.identifier.vancouvercitationWood R, Lawn SD, Caldwell J, Kaplan R, Middelkoop K, Bekker L. Burden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-status. PLoS One. 2011; http://hdl.handle.net/11427/15272.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2011 Wood et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTuberculosisen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherMycobacterium tuberculosisen_ZA
dc.subject.otherHistory of tuberculosisen_ZA
dc.subject.otherRecurrent diseasesen_ZA
dc.subject.otherPublic and occupational healthen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleBurden of new and recurrent tuberculosis in a major South African city stratified by age and HIV-statusen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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