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

Abstract 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.