Wondie Wubet Tazeb, Wubneh Chalachew Adugna, Legesse Bruck Tesfaye, Mekonen Gebrehiwot Berie, Zemariam Alemu Birara, Gebreegziabher Zenebe Abebe, Gedefaw Gezahagn Demsu, Bekele Gemechu Gelan, Regassa Belay Tafa
Department of Pediatrics and Child Health Nursing, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia.
Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2025 Jan 6;20(1):e0317048. doi: 10.1371/journal.pone.0317048. eCollection 2025.
HIV-TB co-infection poses a significant public health threat, notably in sub-Saharan Africa including Ethiopia. Despite this public health problem, studies in Ethiopia regarding the mortality of HIV-TB co-infection patients have been inconsistent, and the overall estimate of mortality was not determined. Accordingly, this meta-analysis aims to assess the magnitude of mortality and predictors among HIV-TB co-infected patients in Ethiopia.
A search of the literature was conducted from three databases (PubMed, Global Index Medicus, and CINHAL), and other sources (Google Scholar, Google, Worldwide Science). All observational studies that reported the mortality of HIV-TB co-infected patients in Ethiopia were included. Joanna Briggs Institute's (JBI) quality appraisal checklist was used to assess the quality of studies. Effect sizes were pooled using the random effects model. Heterogeneity was assessed using Cochrane Q and I2 test statistics, and the prediction interval was determined. Subgroup analysis was conducted by region. To examine the presence of an influential study, a sensitivity analysis was done. Egger's test was used to check publication bias. A non-parametric trim and fill analysis was carried out.
A total of 886 studies were identified, using database searches and keywords. Of these, 37 met the criteria for inclusion. The pooled proportion of mortality among HIV-TB co-infected patients was found to be 18.42% (95% CI:14.27-22.57). In the subgroup analysis, the highest mortality was observed in the Tigray region at 31.86% (95% CI: 7.69-56.03), and the lowest mortality was reported in two general studies in Ethiopia 11.95 (95% CI: 4.19-19.00). From the examined 20 predictors, only four predictors such as Anaemia (HR = 2.25, 95% CI: 1.65-3.07), Poor adherence to ART (HR = 2.42, 95% CI: 1.39-4.21), not taking co-trimoxazole preventive therapy (HR = 1.87, 95% CI: 1.28-2.73), and extrapulmonary tuberculosis (HR = 1.23, 95% CI: 1.01-1.51) were significant predictors.
In Ethiopia, 18.42% of HIV-TB co-infected patients died. Anaemia, poor adherence, not taking CPT, and extrapulmonary tuberculosis were found to be significant predictors. Hence, the concerned stakeholders need to expand and strengthen the HIV-TB collaborative services and attention should be given to patients presented with the aforementioned predictors.
This meta-analysis has been registered in PROSPERO with registration number CRD42023466558.
艾滋病毒与结核病合并感染对公共卫生构成重大威胁，在包括埃塞俄比亚在内的撒哈拉以南非洲地区尤为显著。尽管存在这一公共卫生问题，但埃塞俄比亚关于艾滋病毒与结核病合并感染患者死亡率的研究结果并不一致，且尚未确定总体死亡率估计值。因此，本荟萃分析旨在评估埃塞俄比亚艾滋病毒与结核病合并感染患者的死亡程度及预测因素。
通过三个数据库（PubMed、全球医学索引和CINAHL）以及其他来源（谷歌学术、谷歌、世界科学数据库）进行文献检索。纳入所有报告埃塞俄比亚艾滋病毒与结核病合并感染患者死亡率的观察性研究。使用乔安娜·布里格斯研究所（JBI）的质量评估清单来评估研究质量。采用随机效应模型汇总效应量。使用Cochrane Q和I²检验统计量评估异质性，并确定预测区间。按地区进行亚组分析。为检查是否存在有影响力的研究，进行了敏感性分析。使用Egger检验检查发表偏倚。进行了非参数修剪和填充分析。
通过数据库搜索和关键词共识别出886项研究。其中，37项符合纳入标准。艾滋病毒与结核病合并感染患者的合并死亡率为18.42%（95%置信区间：14.27 - 22.57）。在亚组分析中，提格雷地区的死亡率最高，为31.86%（95%置信区间：7.69 - 56.03），埃塞俄比亚的两项综合研究报告的死亡率最低，为11.95（95%置信区间：4.19 - 19.00）。在所检查的20个预测因素中，只有四个预测因素具有显著性，即贫血（风险比 = 2.25，95%置信区间：1.65 - 3.07）、抗逆转录病毒治疗依从性差（风险比 = 2.42，95%置信区间：1.39 - 4.21）、未接受复方新诺明预防性治疗（风险比 = 1.87，95%置信区间：1.28 - 2.73）和肺外结核（风险比 = 1.23，95%置信区间：1.01 - 1.51）。
在埃塞俄比亚，18.42%的艾滋病毒与结核病合并感染患者死亡。贫血、依从性差、未接受复方新诺明预防性治疗和肺外结核被发现是显著的预测因素。因此，相关利益攸关方需要扩大和加强艾滋病毒与结核病协作服务，并应关注出现上述预测因素的患者。
本荟萃分析已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42023466558。
