ArticleBMJ global health2025
Impact of increasing CD4 count threshold eligibility for antiretroviral therapy initiation on advanced HIV disease and tuberculosis prevalence and incidence in South Africa: an interrupted time series analysis.
Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Advanced HIV disease among newly diagnosed clients identified through community- and facility-based HIV testing services in Eswatini: a cross-sectional study.Frontiers in public health · 2026Article
- A retrospective analysis of tuberculosis notification trends and spatial distribution in South Africa, 2005-2012.Discover public health · 2026Article
- Using interpretable decision trees to explore TB-HIV integration under data constraints: a proof-of-concept analysis.Frontiers in tuberculosis · 2026Article
- Quality assessment of data for decentralised antiretroviral therapy referrals and laboratory results in the South African national electronic HIV management register TIER.Net.PLOS global public health · 2026Article
- Monitoring for advanced disease in the universal test and treat era: trends in CD4 count testing in South Africa.BMC global and public health · 2025Article
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13 authors.
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Abstract
introductionWe investigated the impact of increasing CD4 count eligibility for antiretroviral therapy (ART) initiation on advanced HIV disease (AHD) and tuberculosis (TB) prevalence and incidence among people living with HIV (PLHIV) in South Africa.
methodsWe conducted an interrupted time series analysis with de-identified data of PLHIV aged ≥15 years initiating ART between April 2012 and February 2020 at 65 primary healthcare clinics in KwaZulu-Natal, South Africa. Outcomes included monthly proportions of new ART initiators presenting with AHD (CD4 count <200 cells/µL) and TB disease. We created a cohort of monthly ART initiators without TB and evaluated the cumulative incidence of TB within 12 months follow-up. We used segmented binomial regression models to estimate relative risks (RR) of outcomes, allowing for a step and slope change after expanding the ART initiation CD4 count eligibility from <350 to <500 cells/µL in January 2015 and following Universal Test and Treat (UTT) implementation in September 2016.
resultsAmong 209 984 participants, median age was 32 (range: 26-38), and 141 499 (67.4%) were female. After January 2015, the risk of AHD at initiation decreased in step by 25.0% (RR=0.750, 95% CI 0.688 to 0.812) and further reduced by 26.9% following UTT implementation (RR=0.731, 95% CI 0.681 to 0.781). The risk of TB at initiation also decreased in step by 27.6% after January 2015 (RR=0.724, 95% CI 0.651 to 0.797) and further decreased by 17.4% after UTT implementation (RR=0.826, 95% CI 0.711 to 0.941) but remained stable among initiators with AHD. Among the incidence cohort, we saw a step decrease in the risk of new TB by 31.4% (RR=0.686, 95% CI 0.465 to 0.907) following UTT implementation. Among the incidence cohort with AHD, there was weak evidence of a step decrease in the risk of new TB (RR=0.755, 95% CI 0.489 to 1.021), but the slope decreased by 9.7% per month (RR=0.903, 95% CI 0.872 to 0.934) following UTT implementation.
conclusionsOur data support the added benefit of decreased TB co-burden with expanded ART access. Early diagnosis and immediate linkage to care should be prioritised among PLHIV.
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