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Provision of antiretroviral therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) has been associated with population level decreases in <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> notification rates. We aimed to assess whether the progressive scale\u2010up of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> provision over the past nine years has had an effect on population level trends of <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> notification in Uganda stratified by sex and <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study area consisted of Kampala and eight surrounding districts. Annual <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> notifications and mid\u2010year populations were used to calculate notification rates per 100,000 population from the study area. Numbers alive and retained on <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> were used to calculate <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> coverage, overall and by sex. <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> notification rates (<jats:styled-content style=\"fixed-case\">TBNR<\/jats:styled-content>s) overall and stratified by sex and <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> status were calculated for the period 2009 to 2017. Trends in <jats:styled-content style=\"fixed-case\">TBNR<\/jats:styled-content>s before and after rollout of universal <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> for pregnant women in 2013 were examined using Poisson regression models. To gain insight into the trends in <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4+ T\u2010cell counts at <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation over the study period, we performed a sub analysis of patient level data from the Infectious Diseases Institute clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 2009 to 2017, <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> coverage increased by 27.6% among men and by 35.4% among women. <jats:styled-content style=\"fixed-case\">TBNR<\/jats:styled-content>s declined during the same period. Overall, the average annual percentage decline in <jats:styled-content style=\"fixed-case\">TBNR<\/jats:styled-content>s was \u22123.5% (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22123.7% to \u22123.3%), (\u22122.3% (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22122.6% to \u22121.9%) in men and \u22125.4% (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22125.7% to \u22125.0%) in women). <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> coverage increased after 2013 but this was not associated with an accelerated decline in overall <jats:styled-content style=\"fixed-case\">TBNR<\/jats:styled-content>s among <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010positive persons \u22123.6% before 2013 and \u22125.2% after 2013; p\u00a0=\u00a00.33. The proportion of patients initiating <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> with <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4+ T\u2010cell count\u00a0\u2264\u00a0200\u00a0cells\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> did not decrease significantly after 2013 (42.2% to 32.2%<jats:italic>, p\u00a0=\u00a0<\/jats:italic>0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> scale\u2010up was temporally associated with a decline in <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> notification rates, the achieved rates of decline are below those required to achieve the End <jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content> Targets. Additional investments in tuberculosis control should include efforts to promote earlier care seeking and <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> initiation among <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010positive persons.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25394","type":"journal-article","created":{"date-parts":[[2019,9,17]],"date-time":"2019-09-17T06:20:11Z","timestamp":1568701211000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anti\u2010retroviral therapy scale\u2010up and its impact on sex\u2010stratified tuberculosis notification trends in Uganda"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-7082","authenticated-orcid":false,"given":"Stella","family":"Zawedde\u2010Muyanja","sequence":"first","affiliation":[{"name":"The Infectious Diseases Institute College of Health Sciences Makerere University Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukari C","family":"Manabe","sequence":"additional","affiliation":[{"name":"The Infectious Diseases Institute College of Health Sciences Makerere University Kampala Uganda"},{"name":"Division of Infectious Diseases Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Musaazi","sequence":"additional","affiliation":[{"name":"The Infectious Diseases Institute College of Health Sciences Makerere University Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank R","family":"Mugabe","sequence":"additional","affiliation":[{"name":"Ministry of Health National Tuberculosis and Leprosy Program Kampala Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5677-939X","authenticated-orcid":false,"given":"Jennifer M","family":"Ross","sequence":"additional","affiliation":[{"name":"Departments of Global Health and Medicine University of Washington Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Hermans","sequence":"additional","affiliation":[{"name":"Department of Global Health Amsterdam Institute for Global Health and Development Amsterdam UMC University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,9,16]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"United Nations.About the Sustainable Development Goals[Internet]. 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