HIV/TB co-infection prevalence and treatment outcomes in Democratic Republic of the Congo from 2005 to 2020: Systematic review and meta-analysis

The Democratic Republic of the Congo (DRC), is listed among the 22 highest countries with high burden tuberculosis (TB) in the world. In 2017, it occupied 9th rank in the world and 2nd rank in Africa. TB and HIV coinfection is a major public health issue in the DRC as the percentage of people living with HIV/TB is increasing. However, the country lacks a high evidence study that may depict the overview of HIV/TB co-infection. We have undertaken a systematic review to estimate the prevalence and outcomes of TB/HIV co-infection among TB infected patients in the DRC as well as its different provinces. This systematic review and meta-analysis was conducted to determine the prevalence and treatment outcomes of HIV/TB co-infection in DRC. Biomedical databases including PubMed, Medline, Google Scholar, and Cochrane Library were systematically and comprehensively searched. Only studies reporting the comparison between HIV/TB co-infection and TB infection were included in the success and unsuccessful HIV/TB rates. Data were extracted using a standardized data extraction tool prepared in Microsoft Excel exported to Revman version 5.3 and JASP version 1.14.0 statistical software. I2 test were performed to assess the heterogeneity. Since the included studies exhibited high heterogeneity, a random effects model meta- analysis was used to estimate the pooled prevalence and odds ratios. Finally, subgroup, sensitivity and meta-regression analysis were undertaken to investigate the sources of heterogeneity. The result of 26 studies revealed that the pooled prevalence of HIV/TB co-infection in DRC was estimated at 11% [7%-17%]. The subgroup analysis revealed 12% [6%-25%] for Kinshasa province, 13% [4%-43%] for Haut-Katanga province, 11% [3%-35%] for North Kivu province, 13% [1%-133%] for South Kivu province, 11% [3%-38%] for Tshopo province, 3% [2%-3%] for Tanganyika province and 1% [1%-2%] for North Ubangi. HIV/TB co-infection had 67% risk reduction of success rate treatment compared to TB infection (OR 0.33, 95%CI: 0.23-0.48, P < 0.001) and HIV/TB co-infection had a high risk of unsuccessful rate outcomes compared to TB infection (OR 3.76, 95%: 2.60-5.44, P < 0.001). Meta-regression showed that the HIV/TB co-infection prevalence was an estimated 0.012 % higher than those based on best-estimate procedure based on the studies mean age (P = 0.028) and HIV/TB co-infection incidence was 0.016% higher than those on best-estimate based on the regions TB mortality rate. As a summary, HIV/TB co-infection is a serious public health issue in the Democratic Republic of the Congo. Although HIV/TB co-infection is estimated to be 11% of all TB infections, HIV/TB co-infection requires more focused attention due to the high risk of poor outcomes. Good national and provincial health policies on ART coverage are substantial to achieve the WHO's HIV and TB goals.