Saito, SuzueMpofu, PhilaniCarter, E. JaneDiero, LameckWools-Kaloustian, Kara K.Yiannoutsos, Constantin T.Musick, Beverly S.Tsiouris, SimonSomi, Geoffrey R.Ssali, JohnNash, DenisElul, Batya2018-08-092018-08-092016-04-01Saito, S., Mpofu, P., Carter, E. J., Diero, L., Wools-Kaloustian, K. K., Yiannoutsos, C. T., … Elul, B. (2016). Declining Tuberculosis Incidence among People Receiving HIV Care and Treatment Services in East Africa, 2007–2012. Journal of Acquired Immune Deficiency Syndromes (1999), 71(4), e96–e106. http://doi.org/10.1097/QAI.0000000000000896https://hdl.handle.net/1805/17065Antiretroviral therapy (ART) reduces the risk of Tuberculosis (TB) among people living with HIV (PLWH). With ART scale-up in sub-Saharan Africa over the past decade, incidence of TB among PLWH engaged in HIV care is predicted to decline. METHODS: We conducted a retrospective analysis of routine clinical data from 168,330 PLWH receiving care at 35 facilities in Kenya, Tanzania, and Uganda during 2003-2012, participating in the East African region of the International Epidemiologic Databases to Evaluate AIDS. Temporal trends in facility-based annual TB incidence rates (per 100,000 person years) among PLWH and country-specific standardized TB incidence ratios using annual population-level TB incidence data from the World Health Organization were computed between 2007 and 2012. We examined patient-level and facility-level factors associated with incident TB using multivariable Cox models. RESULTS: Overall, TB incidence rates among PLWH in care declined 5-fold between 2007 and 2012 from 5960 to 985 per 100,000 person years [P = 0.0003] (Kenya: 7552 to 1115 [P = 0.0007]; Tanzania: 7153 to 635 [P = 0.0025]; Uganda: 3204 to 242 [P = 0.018]). Standardized TB incidence ratios significantly decreased in the 3 countries, indicating a narrowing gap between incidence rates among PLWH and the general population. We observed lower hazards of incident TB among PLWH on ART and/or isoniazid preventive therapy and receiving care in facilities offering TB treatment onsite. CONCLUSIONS: Annual TB incidence rates among PLWH significantly declined during ART scale-up but remained higher than the general population. Increasing access to ART and isoniazid preventive therapy and co-location of HIV and TB treatment may further reduce TB incidence among PLWH.en-USPublisher PolicyTB incidence ratesTuberculosisTB/HIVHIVARTSub-Saharan AfricaArticle