Incidence and Predictors of tuberculosis among HIV patients after initiation of ART treatment in Ethiopia: A systematic review and Meta-analysis

Abstract Background: Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. Even though, several primary studies have been conducted on incidence of tuberculosis among HIV infected individuals in Ethiopia, national level TB incidence is unknown. Therefore, this systematic review and meta-analysis study is aimed to study TB incidence rate and its predictors among HIV infected individuals in Ethiopia. Methods: We conducted extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, HINARI and Scopus literature. Searching terms used were “incidence”, “predictors”, “Tuberculosis”, “HIV infected patients”, and “Ethiopia”. We used Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. The meta-analysis and Meta regressions were conducted using STATA 14 software. The pooled meta-analysis and Meta regression were computed to present the pooled incidence rate and predictors of tuberculosis among HIV infected patients after initiation of ART therapy with a 95% confidence interval Results: Among a total of 189 studies, 11 studies were included in this analysis. The estimated pooled incidence rate of TB per 100-person year observation (PYO) among HIV infected patients after initiation of ART therapy was 4.8(95% CI: 3.69–5.83). In subgroup analysis, the estimated pooled incidence of tuberculosis showed a slightly difference between Adults and children after initiation of ART treatment, which was 4.3 (95% CI: 2.96, 5.71) and 5.0 (95% CI: 3.51, 6.50), respectively. Significant predictor of pooled estimate of meta-analysis showed that being anemic patients (2.30, 95% CI: 1.75, 3.02); on WHO clinical stage III & IV (2.26, 95% CI (1.70, 3.02); and not on CPT (2.16, 95% CI: 1.23, 3.72) and a Meta regression revealed that CD4 <200 cells/mm 3 (2.12, 95% CI: 1.17, 3.86) was positively significant predictors among Adults. Conclusions: The current systematic review and meta-analysis showed that the pooled incidence of TB among HIV patients was found to lower than WHO 2018 national estimate. Being anemic, WHO stage III& IV, not on CPT, CD4 <200cells/µl and being male were significant predictors of Tuberculosis. Therefore, the existing strategies to decrease TB should be strengthening.