Prevalence of current substance and hazardous alcohol use among people with HIV and tuberculosis disease and its impact on tuberculosis treatment outcomes: A systematic review

Objective To examine the prevalence of current substance and hazardous alcohol use in people with HIV and tuberculosis (TB) disease and its impact on TB treatment outcomes. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE, Scopus, PsycInfo and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 3 April 2025. Risk of bias was assessed using the ROBINS-E tool. Prevalence estimates were synthesized using a random-effects model with between-study heterogeneity assessed via the I 2 statistic. Results Eighteen studies were included. Prevalence of current hazardous alcohol use ranged from 7.4% to 33.7%, with a pooled estimate of 19.1% (95% CI [16.1%-22.5%], I 2 = 92.5%) across 5310 individuals. Current substance use (excluding alcohol) ranged from 1.2% to 90.9%, with a pooled prevalence of 25.1% (95% CI [15.3%-38.8%], I 2 = 96.8%) among 3709 individuals. Pooled prevalence estimates varied across WHO regions, with the Western Pacific Region reporting the highest prevalence of hazardous alcohol use (20.4%) and the Region of the Americas leading in substance use (29.9%). Only three studies assessed TB treatment, all showing poorer outcomes among people with substance use disorders. Heterogeneity and small sample size precluded pooled analysis. Most studies had high or very high risk of bias, primarily due to confounding, missing data and inconsistent definitions of substance and hazardous alcohol use. Conclusion Current substance and hazardous alcohol use occurs frequently among people with HIV and TB, varying widely depending on the population. However, current substance and hazardous alcohol use, as opposed to any history of substance use, is rarely assessed systematically.