The scale-up of antiretroviral therapy coverage was strongly associated with the declining tuberculosis morbidity in Africa during 2000-2018.

OBJECTIVES:Antiretroviral therapy (ART) reduces the risk of tuberculosis (TB). We aimed to examine the association between ART coverage scale-up on the changes in TB incidence in Africa from 2000 to 2018. STUDY DESIGN:The design of the study is a retrospective ecological study. METHODS:Data for 54 countries were obtained from several institutional-based sources, including the World Health Organization, the Joint United Nations Programme on HIV/AIDS, and the World Bank. A fixed-effects regression method of longitudinal data analysis was used to estimate the association between ART coverage and changes in TB incidence rate during 2000-2018. Statistical analyses were conducted using STATA 15.0/IC. RESULTS:The TB incidence declined significantly, by an average of 2.3% per year during 2000-2018. The highest significant declines occurred in eastern and southern Africa. In adjusted analysis, each 1% increase in ART coverage was associated with a 3.97 per 100,000 decline of TB incidence. However, the marginal effects of ART on overall population TB incidence was dependent on the prevalence of human immunodeficiency virus infection. CONCLUSIONS:Investment in the widespread scale-up of ART may contribute to the control of the TB epidemic in Africa. However, interventions are also needed to augment the effect of ART on population TB incidence.