Distribution of Mycobacterium Tuberculosis Lineages and Sublineages by Drug Profile in Ethiopia: A Systematic Review and Meta-Analysis

Background Mycobacterium tuberculosis lineages exhibit variability in geographic distribution, transmissibility, and disease phenotype. Ethiopia is one of the countries with the highest prevalence of tuberculosis. The aim of this study was to summarize the proportion of lineages and sublineages by drug resistance profile and TB type. Methods The results were reported in accordance with the PRISMA guidelines. The study protocol was registered with ID CRD42024498336. Studies reporting Mtb lineages and sublineages with drug resistance profiles published between March 2010 and June 2024 were included. I² was used to evaluate heterogeneity. A p-value less than 0.05 and an I² value greater than 75% indicated significant heterogeneity. Results A total of 5554 Mycobacterium tuberculosis strains were included from 32 studies. The percentage of East African Indian was 26.8% (95% CI: 22.6-30.6), and Euro-American was 64.1% (95% CI: 59.6-68.4) among all TB cases. In studies that included only multidrug- or rifampicin-resistant cases, the percentage of East African Indian was 33.78% (95% CI: 27.81-39.74), while Euro-American was 52.96% (95% CI: 41.32-64.61). Euro-American, followed by East African-Indian, was the predominant lineage across locations and TB types; however, East African-Indian was significantly higher in the Amhara region for both pulmonary TB and extra-pulmonary TB (EPTB) than in Addis Ababa. As defined by spoligotyping, T3ETH (28.22%), CAS1-Kili (18.13%), and T1 (11.54%) were the three most common sublineages among MDR/RR TB cases, while CAS1-Delhi (20.23%), T1 (16.71%), and T3ETH (13.50%) were the most common among susceptible cases. Conclusion The three most prevalent Mtb sublineages significantly contribute to the TB and drug resistance epidemic; such data are vital for prioritizing contact tracing. The variation in EAI percentage among EPTB cases across regions likely reflects the influence of genetic variation on the prevalence of EPTB. This suggests a need for genomic surveillance to inform the development of more targeted interventions.