Prevalence, clusters, and burden of complex tuberculosis multimorbidity in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Objectives: The co-occurrence of tuberculosis (TB) and multiple chronic communicable and non-communicable diseases is a growing concern in low- and middle-income countries (LMICs). Understanding this 'complex TB multimorbidity' (cTBMM) can contribute to improved patient care. We aimed to synthesise the prevalence of clusters of cTBMM and their impact on patient outcomes. Design: Systematic review and meta-analysis. Setting: LMICs. Papers: We searched major databases from inception to 01/10/2020 to identify observational studies reporting primary (prevalence or risk) or secondary (related to disease burden) outcome data for people in LMICs with cTBMM. Titles, abstracts and full text screening, data extraction, and quality assessment were done in duplicate by independent reviewers, and random-effects meta-analyses were performed. Primary and secondary outcome measures: Prevalence or risk of cTBMM (primary); any measure of burden of disease (secondary). Results: From 21,884 search results, 82 studies representing 773,828 TB patients were included, reporting data on 78 different clusters of cTBMM. In TB patients, the most prevalent co-occurring conditions where depression and anxiety (15.3%, 95% confidence interval [CI] 10.7%-20.5%, 3 studies, 1,473 participants, I2=64%), HIV and anxiety (15.2%, 95%CI 11.3%-19.7%, 4 studies, 1,413 participants, I2=77%), and HIV and post-traumatic stress disorder (14.8%, 95%CI 13.9%-15.8%, 2 studies, 5,400 participants). Sparse evidence indicated lower treatment success and higher risks of death in people with cTBMM. Conclusions: Although limited by high heterogeneity, this first systematic review and meta-analysis on cTBMM highlights that multiple conditions co-occurring in TB patients are common and that mental disorders often cluster together or with HIV. Further research assessing the burden of cTBMM and identifying effective health systems responses is required. Registration: Prospero CRD42020214021.

Prevalence and risks of tuberculosis multimorbidity in low-income and middle-income countries: a meta-review

“…Considering the potential multiple-way synergies between multiple chronic conditions, a systematic review of the literature on this topic is sorely needed. This evidence gap is addressed in a complementary review by our group 33…”

“…This evidence gap is addressed in a complementary review by our group. 33 We did not find any systematic reviews focusing on CCDs and NCDs in people with zoonotic TB (zTB). While this type of TB was estimated to represent 1.4% of all TB cases in 2019, this number is likely to be an underestimate, as there are poor surveillance programmes, underreporting and lack of laboratory confirmation of the causative agent.…”