Prevalence and burden of HIV–TB co-infection among pregnant women: A systematic review and meta-analysis

Abstract

Objectives This study aimed to systematically evaluate the prevalence and burden of human immunodeficiency virus–tuberculosis (HIV–TB) co-infection among pregnant women. Method ology: A comprehensive systematic search was conducted in PubMed, Scopus, and Google Scholar to identify eligible studies published in English between 2015 and 2025. Study selection, data extraction, quality assessment, and reporting adhered to the PROSPERO-registered protocol and Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Pooled prevalence estimates were calculated using a random-effects logistic regression model implemented in R statistical software. Heterogeneity was assessed using Cochran's Q statistic, τ2, and the I2 statistic. Subgroup analyses were conducted according to geographical region, HIV prevalence strata, and study design. Publication bias was evaluated using funnel plots and Egger's regression test. Leave-one-out sensitivity analysis was performed to assess the robustness of the pooled estimates. Results Twenty-three studies involving 118,174,014 pregnant women were included in the systematic review, where 17 studies comprising 57,399,949 pregnant women contributed quantitative data to the meta-analysis. The pooled prevalence of HIV–TB co-infection among pregnant women was 19.5% (95% confidence interval (95% CI): 3.1–65.0%), with considerable heterogeneity (I2 = 99.9%). Subgroup analyses obtained significantly higher prevalence estimates in sub-Saharan Africa (30.8%; 95% CI: 10.1–63.8%), high HIV prevalence settings (51.8%; 95% CI: 25.1–77.5%), and prospective or longitudinal cohort studies (67.7%; 95% CI: 23.5–93.4%) (all p < 0.001). Diagnostic approaches included enzyme-linked immunosorbent assay, GeneXpert MTB/RIF, sputum microscopy, QuantiFERON-TB Gold Plus, tuberculin skin test, HIV RNA quantification, CD4 T-cell count, and smear microscopy. HIV–TB co-infection was associated with adverse maternal and neonatal outcomes. Conclusion HIV–TB co-infection remains a substantial burden among pregnant women, particularly in high HIV prevalence settings and Sub-Saharan Africa, necessitating strengthened integrated screening, early diagnosis, and targeted interventions to improve maternal and child health outcomes in resource-constrained settings. PROSPERO ID CRD42025646201.