Prevalence and Predictors of Anxiety among Tuberculosis Patients in India: A Systematic Review and Meta-analysis Protocol

Abstract Introduction: Anxiety in tuberculosis (TB) patients can affect quality of life, treatment adherence, and outcomes. Understanding the prevalence and factors contributing to anxiety in TB patients can help program managers enhance patient outcomes. Objectives: The primary objective of this review will be to estimate the pooled prevalence and identify factors associated with anxiety in TB patients in India. Methods: Data will be sourced from four databases: PUBMED, Scopus, DOAJ, and EMBASE databases and cross-references. Titles, abstracts, and full texts will be separately reviewed by two reviewers before a mutually agreed-upon inclusion is decided. The review will include peer-reviewed, English-language, original studies published between 2004 and 2024. The pooled prevalence of anxiety in TB patients in India will be stratified by types of TB cases (DS vs. DR-TB), types of study tools used, and types of study designs employed. The pooled prevalence will be visualized through forest plots at a 95% confidence interval. Heterogeneity will be assessed using I 2 statistics and Galbraith plots, whereas publication bias will be assessed using Egger’s test, Beggs’s test, the trim-and-fill method, and funnel plots. Sensitivity analysis will be performed through leave-one-out meta-analysis. The quality of the included studies will be assessed using the Newcastle–Ottawa Scale (NOS), the Modified-NOS for observational studies, and the mixed methods appraisal tool, if mixed methods studies will be included in the study. The Grading of Recommendations Assessment, Development and Evaluation system will be employed to assess the quality of evidence and recommendations. Systematic Review Registration: As per the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol, this protocol has been registered with PROSPERO (ID: CRD420251154885).