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Meta-Analysis
. 2018 Jul;21(7):e25162.
doi: 10.1002/jia2.25162.

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta-analyses

Marriott Nliwasa  1   2   3 , Peter MacPherson  4 , Ankur Gupta-Wright  2   3 , Mphatso Mwapasa  1 , Katherine Horton  3 , Jon Ø Odland  5   6 , Clare Flach  7 , Elizabeth L Corbett  1   2   3
Affiliations
Meta-Analysis

High HIV and active tuberculosis prevalence and increased mortality risk in adults with symptoms of TB: a systematic review and meta-analyses

Marriott Nliwasa et al. J Int AIDS Soc. 2018 Jul.

Abstract

Introduction: HIV and tuberculosis (TB) remain leading causes of preventable death in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends HIV testing for all individuals with TB symptoms, but implementation has been suboptimal. We conducted a systematic literature review and meta-analyses to estimate HIV and TB prevalence, and short-term (two to six months) mortality, among adults with TB symptoms at community- and facility level.

Methods: We searched Embase, Global Health and MEDLINE databases, and reviewed conference abstracts for studies reporting simultaneous HIV and TB screening of adults in LMICs published between January 2003 and December 2017. Meta-analyses were performed to estimate prevalence of HIV, undiagnosed TB and mortality risk at different health system levels.

Results: Sixty-two studies including 260,792 symptomatic adults were identified, mostly from Africa and Asia. Median HIV prevalence was 19.2% (IQR: 8.3% to 40.4%) at community level, 55.7% (IQR: 20.9% to 71.2%) at primary care level and 80.7% (IQR: 73.8% to 84.6%) at hospital level. Median TB prevalence was 6.9% (IQR: 3.3% to 8.4%) at community, 20.5% (IQR: 11.7% to 46.4%) at primary care and 36.4% (IQR: 22.9% to 40.9%) at hospital level. Median short-term mortality was 22.6% (IQR: 15.6% to 27.7%) among inpatients, 3.1% (IQR: 1.2% to 4.2%) at primary care and 1.6% (95% CI: 0.45 to 4.13, n = 1 study) at community level.

Conclusions: Adults with TB symptoms have extremely high prevalence of HIV infection, even when identified through community surveys. TB prevalence and mortality increased substantially at primary care and inpatient level respectively. Strategies to expand symptom-based TB screening combined with HIV and TB testing for all symptomatic individuals should be of the highest priority for both disease programmes in LMICs with generalized HIV epidemics. Interventions to reduce short-term mortality are urgently needed.

Keywords: HIV; Tuberculosis; health systems; mortality; policy; screening.

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Figures

Figure 1
Figure 1
PRISMA flow diagram for process of selecting included studies. (a) Reasons for exclusion are explained in supplementary material. (b) One study, Boehme et al., was a multisite study (six sites), four sites were eligible; the total number of individual studies was 62. (c) Two studies did not report on results of TB testing.
Figure 2
Figure 2
Summary HIV prevalence, TB prevalence and mortality risk at six months.
See this image and copyright information in PMC

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