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Int J Tuberc Lung Dis. 2011 Jul;15(7):933-7. doi: 10.5588/ijtld.10.0666.

Reduced tuberculosis case notification associated with scaling up antiretroviral treatment in rural Malawi.

Author information

Médecins Sans Frontières (MSF), Medical Department (Operational Research), MSF-Luxembourg, Brussels Operational Centre, Luxembourg.



To report on the trends in new and recurrent tuberculosis (TB) case notifications in a rural district of Malawi that has embarked on large-scale roll-out of antiretroviral treatment (ART).


Descriptive study analysing TB case notification and ART enrolment data between 2002 and 2009.


There were a total of 10,070 new and 755 recurrent TB cases. ART scale-up started in 2003, and by 2007 an estimated 80% ART coverage had been achieved and was sustained thereafter. For new TB cases, an initial increase in case notifications in the first years after starting ART (2002-2005) was followed by a highly significant and sustained decline from 259 to 173 TB cases per 100,000 population (χ(2) for trend 261, P < 0.001, cumulative reduction for 2005-2009 = 33%, 95%CI 27-39). For recurrent TB, the initial increase was followed by a significant drop, from 20 to 15 cases/100,000 (χ(2) for linear trend = 8.3, P = 0.004, constituting a 25% (95%CI 9-49) cumulative reduction between 2006 and 2009. From 2005 to 2009, ART averted an estimated 1164 (95%CI 847-1480) new TB cases and 78 (95%CI 23-151) recurrent TB cases.


High ART implementation coverage is associated with a very significant declining trend in new and recurrent TB case notifications at population level.

[Indexed for MEDLINE]

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