SEARCHMETA-ANALYSISinfectious disease, epidemiology

meta-analysis·infectious disease, epidemiology, public health, systematic review, meta-analysis·PMC10507970

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

BMC Infectious Diseases · 2 authors, 2 centres

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TL;DR

A systematic review and meta-analysis of 43 studies found that the pooled incidence rate of tuberculosis among HIV-positive persons in Sub-Saharan Africa was 3.49 per 100 person-years.

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This systematic review and meta-analysis pooled 43 cohort studies published between 2000 and 2022 from Sub-Saharan Africa. A random-effects model was used to estimate the pooled TB incidence rate among HIV-positive persons, which was 3.49 per 100 person-years (95% CI: 2.88–4.17), higher than the WHO 2022 Africa regional estimate. Subgroup analysis showed similar rates in adults (3.79) and children (3.42). ART was protective (AHR = 0.53). Most studies used retrospective designs, which may affect outcome measurement reliability.

STUDY TYPE

meta-analysis

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infectious disease

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ORIGINAL PAPER

PMC10507970

The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis

BMC Infectious Diseases

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ABSTRACT

Abstract Background Tuberculosis, along with HIV, is the leading cause of mortality and morbidity globally. Despite the fact that several primary studies have been conducted on the incidence rate of tuberculosis in HIV-infected people in Sub-Saharan Africa, the regional-level tuberculosis incidence rate remains unknown. The objective of this study is to determine the tuberculosis incidence rate and its associated factors in HIV-infected people in Sub-Saharan Africa. Methods A systematic review and meta-analysis were conducted by searching four databases for studies published in English between January 1, 2000, and November 25, 2022. The study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. To assess the quality of the studies, the Joanna Briggs Institute critical appraisal checklist was used. A random-effects model meta-analysis was used to determine the pooled incidence of tuberculosis using STATA version 15. The I 2 heterogeneity test was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. Funnel plots and Egger’s regression tests were used to investigate publication bias. The pooled estimate predictors of tuberculosis incidence rate with a 95% confidence interval were also determined using the hazard ratio of each factor (HR). Results Out of a total of 3339 studies, 43 were included in the analysis. The overall pooled incidence rate of tuberculosis in HIV-infected people was 3.49 per 100 person-years (95% CI: 2.88–4.17). In the subgroup analysis, the pooled incidence rate of tuberculosis in HIV-infected children was 3.42 per 100 person-years (95% CI: 1.78, 5.57), and it was 3.79 per 100 person-years (95% CI: 2.63, 5.15) in adults. A meta-analysis revealed that underweight (AHR = 1.79, 95% CI: 1.61–1.96), low CD4 count (AHR = 1.23, 95% CI: 1.13–1.35), male gender (AHR = 1.43, 95% CI: 1.22–1.64), advanced WHO clinical stages (AHR = 2.29, 95% CI: 1.34–3.23), anemia (AHR = 1.73, 95% CI: 1.34–2.13), bedridden or ambulatory (AHR = 1.87, 95%), lack of isoniazid preventive therapy (AHR = 3.32, 95% CI: 1.08–2.28), and lack of cotrimoxazole (AHR = 1.68, 95% CI: 1.08–2.28) were risk factors for tuberculosis incidence. HIV patients who received antiretroviral therapy had a 0.53 times higher risk of acquiring tuberculosis than HIV patients who did not receive antiretroviral therapy (AHR = 0.53; 95% CI: 0.3–0.77). Conclusion In this systematic review and meta-analysis study, the incidence rate of tuberculosis among HIV-positive people was higher than the WHO 2022 Africa regional estimated report. To reduce the incidence of tuberculosis among HIV patients, HIV patients should take isoniazid prevention therapy (IPT), cotrimoxazole prophylaxis, and antiretroviral therapy (ART) without interruption, as well as increase the frequency and diversity of their nutritional intake. Active tuberculosis screening should be increased among HIV-infected people. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-023-08533-0. Keywords: Incidence, Tuberculosis, HIV, Person, Sub-Saharan Africa

CITATION EXPORT

Temesgen Gebeyehu Wondmeneh, Ayal Tsegaye Mekonnen. The incidence rate of tuberculosis and its associated factors among HIV-positive persons in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Infectious Diseases. (2023). https://doi.org/10.1186/s12879-023-08533-0

AUTHORS

2 · 2 CENTRES

Temesgen Gebeyehu Wondmeneh, Ayal Tsegaye Mekonnen

1Department of Public Health, College of Health Science, Samara University, Samara, Ethiopia
2Department of Biomedical, College of Health Science, Samara University, Samara, Ethiopia