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
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.
Ismail, Nazir Ahmed; Mvusi, Lindiwe; Nanoo, Ananta; Dreyer, Andries; Omar, Shaheed V.; Babatunde, Sanni; Molebatsi, Thabo; Van der Walt, Martie; Adelekan, Adeboye; Deyde, Varough; Ihekweazu, Chikwe; Madhi, S.A.(Elsevier, 2018-07)
BACKGROUND : Globally, per-capita, South Africa reports a disproportionately high number of cases of multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis. We sought to estimate the ...
Children younger than 18 years account for a substantial proportion of patients with tuberculosis worldwide. Available
treatments for paediatric drug-susceptible and drug-resistant tuberculosis, albeit generally eff ective, ...