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

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 I² 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.

Keywords: HIV; Incidence; Person; Sub-Saharan Africa; Tuberculosis.

Fig. 1

Shows PRISMA flow diagram which shows the selection of articles for systematic review and meta-analysis

Fig. 2

Forest plots of the incidence rate of tuberculosis per 100-person-year observation among HIV-positive persons in Sub-Saharan Africa

Fig. 3

A funnel plot of the pooled incidence rate of tuberculosis in HIV/AIDS patients after meta-trim and fill analysis

Fig. 4

Sensitivity analysis of the tuberculosis incidence rate among HIV-infected persons in sub-Saharan Africa

Fig. 5

The association between weight and tuberculosis

Fig. 6

The association between CD4 count and tuberculosis

Fig. 7

The association between gender and tuberculosis

Fig. 8

The association between WHO clinical stages and tuberculosis

Fig. 9

The association between anemia and tuberculosis

Fig. 10

The association between functional capacity and tuberculosis

Fig. 11

The association between prior history tuberculosis and reoccurring tuberculosis

Fig. 12

The association between antiretroviral treatment (ART) and tuberculosis

Fig. 13

The associations between level of adherence and tuberculosis

Fig. 14

The association between isoniazid prevention therapy (IPT) and tuberculosis

Fig. 15

The association between cotrimoxazole prophylaxis and tuberculosis