Tuberculosis and HIV Co-infection in Key Populations: Prevalence, Determinants, and Implications for Health-Related Quality of Life, A Systematic Review and Meta-analysis Autry Alvian Mandagi1*, Jolie Febri Ponamon2, Baithesda3
1Department of Nursing Anaesthesiology, Universitas Sariputra Indonesia Tomohon, Indonesia
2Department of Nursing Science, STIKES Bethesda Tomohon, Indonesia
3Department of Nursing Science, Universitas Sariputra Indonesia Tomohon, Indonesia
Abstract
Background: Tuberculosis (TB) remains the leading opportunistic infection and cause of death among people living with HIV (PLHIV). Key populations-including people who inject drugs, prisoners, sex workers, and other marginalized groups-bear a disproportionate burden, yet evidence on TB/HIV co-infection and its impact on quality of life is fragmented.
Purpose: This study aimed to estimate the pooled prevalence of TB/HIV co-infection among key populations, assess heterogeneity and determinants, and explore implications for health-related quality of life.
Methods: A PRISMA-guided systematic review and meta-analysis were conducted using PubMed, Scopus, Web of Science, and regional databases (2015-2025). Eligible studies were peer-reviewed primary research with ≥-30 participants, reporting quantitative prevalence data on TB/HIV co-infection and quality-of-life outcomes. Risk of bias was
Results: From 1,354 records, four studies met the inclusion criteria, spanning facility-based PLHIV, prisoners, and mixed key populations. Prevalence estimates ranged from 14% to 42%. The pooled prevalence was 27% (95% CI: 18.6-38.6%), indicating that more than one in four PLHIV in key populations also had TB. Heterogeneity was very high, reflecting differences across settings and populations. Risk-of-bias assessment revealed moderate-to-serious concerns in the confounding and selection domains. Evidence on quality of life was limited but suggested substantial impairment among co-infected individuals.
Conclusion: TB/HIV co-infection remains a major health challenge in key populations, with prevalence approaching one-third and significant heterogeneity across contexts.
Implications: Integration of routine TB screening into HIV care, context-specific community interventions, and strengthened policy for prison health and marginalized groups are urgently needed. Future research should incorporate longitudinal designs and standardized measures of quality of life to guide targeted interventions.
Keywords: HIV, key populations, co-infection, Quality of Life, tuberculosis
