Systematic review and meta-analysis finds higher TB prevalence among people living with HIV in Africa
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Key Takeaway
Recognize higher tuberculosis prevalence among people living with HIV in Southern and Eastern Africa based on meta-analysis.
This publication is a systematic review and meta-analysis examining tuberculosis prevalence and notification-to-prevalence ratios among people living with and without HIV in low- and middle-income countries. The analysis included 264,530 participants across Southern and Eastern Africa settings. The primary outcome focused on bacteriologically-confirmed tuberculosis prevalence, while secondary outcomes assessed notification-to-prevalence ratios.
Key findings indicate that bacteriologically-confirmed tuberculosis prevalence was higher among participants living with versus without HIV in 11 of 12 surveys. The pooled effect size showed a relative risk of 3.86, with a 95% credible interval of 2.41-5.53. Regarding notification-to-prevalence ratios, results were higher among participants living with HIV in all examined countries, yielding a relative risk of 1.74 (95% credible interval: 0.59-4.56). Conversely, ratios were lower among participants without HIV, with a relative risk of 0.48 (95% credible interval: 0.17-1.20).
The authors acknowledge limitations, specifically noting limited information on how tuberculosis prevalence differs between people living with and without HIV. They also caution against overstatement of the precision of the notification-to-prevalence ratio estimates given the wide credible intervals. The review does not report adverse events or causality notes.
Practice relevance is not reported in this source. Clinicians should interpret these associations carefully without inferring causation from the observed data. The findings highlight the burden of tuberculosis in this specific population but require cautious application due to the noted limitations and observational nature of the underlying surveys.
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View Original Abstract ↓
Background: Tuberculosis (TB) and human immunodeficiency virus (HIV) are leading causes of infectious disease deaths, with disproportionate impact in low- and middle-income countries (LMICs). Despite well-established biological relationships between these diseases, there is limited information on how TB prevalence differs between people living with and without HIV. Methods: We conducted a systematic review and meta-analysis of TB prevalence surveys conducted in LMICs and published during January 1st 1993-October 13th 2025 (PROSPERO CRD42024503853). We extracted bacteriologically-confirmed TB prevalence estimates stratified by participant HIV status. Surveys that offered HIV testing to all, sputum-collection-eligible, or TB-positive participants were included in the primary analysis. We applied Bayesian meta-regression to estimate pooled risk ratios (RR) of bacteriologically-confirmed TB prevalence among participants living with versus without HIV. Additionally, we estimated country-level and overall TB notification-to-prevalence (N:P) ratios by HIV status. Findings: Of 10,211 potentially relevant publications, 12 TB prevalence surveys--representing 264,530 participants within nine countries in Southern and Eastern Africa--were used in the primary analysis. Reported TB prevalence was higher among participants living with versus without HIV in 11/12 surveys, with an overall pooled RR of 3.86 (95% credible interval: 2.41-5.53). N:P ratios were higher among participants living with HIV in all examined countries. The overall pooled N:P ratios were 1.74 (0.59-4.56) and 0.48 (0.17-1.20) among participants living with versus without HIV, respectively. Interpretation: In Southern and Eastern Africa, bacteriologically-confirmed TB prevalence is three- to six-times higher among people living with HIV. Comparison of prevalence and notification data suggest higher rates of TB diagnosis for people living with versus without HIV, but also indicates substantial delays in the detection of untreated TB cases for both populations. Funding: Wellcome Trust, UK National Institute for Health and Care Research, UK Foreign, Commonwealth and Development Office, NIH.
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