HIV/TB co-infection prevalence and treatment outcomes in Democratic Republic of the Congo from 2005 to 2020: Systematic review and meta-analysis


  • Jacques L. Tamuzi Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • Ley M. Muyaya Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • Patrick Mbuesse Africa Centre of HIV/AIDS management, Stellenbosch University, Cape Town, South Africa


TB, HIV, HIV/TB co-infection, prevalence, outcomes, DRC


The Democratic Republic of the Congo (DRC), is listed among the 22 highest countries with high burden tuberculosis (TB) in the world. In 2017, it occupied 9th rank in the world and 2nd rank in Africa. TB and HIV coinfection is a major public health issue in the DRC as the percentage of people living with HIV/TB is increasing. However, the country lacks a high evidence study that may depict the overview of HIV/TB co-infection. We have undertaken a systematic review to estimate the prevalence and outcomes of TB/HIV co-infection among TB infected patients in the DRC as well as its different provinces. This systematic review and meta-analysis was conducted to determine the prevalence and treatment outcomes of HIV/TB co-infection in DRC. Biomedical databases including PubMed, Medline, Google Scholar, and Cochrane Library were systematically and comprehensively searched. Only studies reporting the comparison between HIV/TB co-infection and TB infection were included in the success and unsuccessful HIV/TB rates. Data were extracted using a standardized data extraction tool prepared in Microsoft Excel exported to Revman version 5.3 and JASP version 1.14.0 statistical software. I2 test were performed to assess the heterogeneity. Since the included studies exhibited high heterogeneity, a random effects model meta- analysis was used to estimate the pooled prevalence and odds ratios. Finally, subgroup, sensitivity and meta-regression analysis were undertaken to investigate the sources of heterogeneity. The result of 26 studies revealed that the pooled prevalence of HIV/TB co-infection in DRC was estimated at 11% [7%-17%]. The subgroup analysis revealed 12% [6%-25%] for Kinshasa province, 13% [4%-43%] for Haut-Katanga province, 11% [3%-35%] for North Kivu province, 13% [1%-133%] for South Kivu province, 11% [3%-38%] for Tshopo province, 3% [2%-3%] for Tanganyika province and 1% [1%-2%] for North Ubangi. HIV/TB co-infection had 67% risk reduction of success rate treatment compared to TB infection (OR 0.33, 95%CI: 0.23-0.48, P < 0.001) and HIV/TB co-infection had a high risk of unsuccessful rate outcomes compared to TB infection (OR 3.76, 95%: 2.60-5.44, P < 0.001). Meta-regression showed that the HIV/TB co-infection prevalence was an estimated 0.012 % higher than those based on best-estimate procedure based on the studies mean age (P = 0.028) and HIV/TB co-infection incidence was 0.016% higher than those on best-estimate based on the regions TB mortality rate. As a summary, HIV/TB co-infection is a serious public health issue in the Democratic Republic of the Congo. Although HIV/TB co-infection is estimated to be 11% of all TB infections, HIV/TB co-infection requires more focused attention due to the high risk of poor outcomes. Good national and provincial health policies on ART coverage are substantial to achieve the WHO's HIV and TB goals.


WHO. Global Tuberculosis Report 2016. Geneva, 2019. http://www.who.into/tb/publiscation/Global

World Health Organization. Global Tuberculosis Report 2020; World Health Organization: Geneva, Switzerland, 2020; Available online:

André E, Rusumba O, Evans CA, Ngongo P, Sanduku P, Elvis MM, Celestin HN, Alain IR, Musafiri EM, Kabuayi JP, le Polain de Waroux O, Aït-Khaled N, Delmée M, Zech F. Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo. Bull World Health Organ. 2018 Aug 1;96(8):522-530.

World Health Organization (2017) Global Tuberculosis Report 2017. GTB, Geneva, WHO/HTM/TB/2017.

Democratic Republic of the Congo. In: UNAIDS [website]. Geneva: World Health Organization; 2020 ( democratic republic of the congo, accessed 18 June 2020).

WHO. Democratic Republic of Congo (DRC) – Integrating tuberculosis screening into community-based HIV activities, 2020.

Global tuberculosis report 2019. Geneva: World Health Organization; 2019

USAID. Monitoring, Evaluation, and coordination contract (mecc): assessment of usaid/DRC tuberculosis portfolio, 2018.

Carrel M, Janko M, Mwandagalirwa MK, Morgan C, Fwamba F, Muwonga J, Tshefu AK, Meshnick S, Emch M. Changing spatial patterns and increasing rurality of HIV prevalence in the Democratic Republic of the Congo between 2007 and 2013. Health Place. 2016;39:79-85.

UNAIDS. Understanding Fast Track: Accelerating Action to End the AIDS Epidemic by 2030. UNAIDS Geneva. 2015. Available online:

Ewetola R, Shah GH, Maluantesa L, Etheredge G, Waterfield K, Mulenga A, Kilundu A. Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo. Int J Environ Res Public Health. 2021;18(10):5341.

Ministry of Health (DRC) National Tuberculosis Program; tuberculosis management guide. Kinshasa: PATI IV; 2008. pp. 22–5. [Google Scholar]

CDC. Global HIV and TB: Country Profile—Democratic Republic of Congo. Centers for Disease Control and Prevention. 2018. Available online: (accessed on 11 May 2021).

Ghoma Linguissi LS, Lucaccioni V, Bates M, Zumla A, Ntoumi F. Achieving sustainable development goals for HIV/AIDS in the Republic of the Congo - Progress, obstacles and challenges in HIV/AIDS health services. Int J Infect Dis. 2018;77:107-112.

Zürcher K, Reichmuth ML, Ballif M, Loiseau C, Borrell S, Reinhard M, Skrivankova V, Hömke R, Sander P, et al. Mortality from drug-resistant tuberculosis in high-burden countries comparing routine drug susceptibility testing with whole-genome sequencing: a multicentre cohort study. The Lancet Microbe 2021; 2(7): 320-330

Mesfin YM, Hailemariam D, Biadgilign S, Kibret KT. Association between HIV/AIDS and multi-drug resistance tuberculosis: a systematic review and meta-analysis. PLoS One. 2014;9(1):e82235.

Gandhi NR, Nunn P, Dheda K, Schaaf HS, Zignol M, van Soolingen D, Jensen P, Bayona J. Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet. 2010 May 22;375(9728):1830-43.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.

Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Accessed August 01, 2021.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003;327(7414):557. pmid:12958120

Shah GH, Ewetola R, Etheredge G, Maluantesa L, Waterfield K, Engetele E, Kilundu A. Risk Factors for TB/HIV Coinfection and Consequences for Patient Outcomes: Evidence from 241 Clinics in the Democratic Republic of Congo. Int J Environ Res Public Health. 2021 May 13;18(10):5165.

Yotebieng M, Tabala M, Batumbula ML, Wenzi L, Basaki E, Mungoyo E, Mangala R, Behets F. Impact of WHO 2010 Guidelines on Antiretroviral Therapy Initiation among Patients with HIV-Associated Tuberculosis in Clinics with and without Onsite HIV Services in the Democratic Republic of Congo. Tuberc Res Treat. 2016;2016:1027570.

Edmonds A, Lusiama J, Napravnik S, Kitetele F, Van Rie A, Behets F. Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children. Int J Epidemiol. 2009;38(6):1612-21.

Henegar C, Behets F, Vanden Driessche K, Tabala M, Bahati E, Bola V, Van Rie A. Mortality among tuberculosis patients in the Democratic Republic of Congo. Int J Tuberc Lung Dis. 2012;16(9):1199-204.

Lu Y. Prevalence, risk factors and outcomes of multidrug resistant Tuberculosis identified by GeneXpert MTB/RIF Assay in Bukavu, Democratic Republic of the Congo. Master's Thesis, University of Pittsburgh, 2016. (Unpublished)

Akilimali PZ, Kashala-Abotnes E, Musumari PM, Kayembe PK, Tylleskar T, Mapatano MA. Predictors of Persistent Anaemia in the First Year of Antiretroviral Therapy: A Retrospective Cohort Study from Goma, the Democratic Republic of Congo. PLoS One. 2015;10(10):e0140240.

Kakisingi C, Mukuku O and Kajimb P. Treatment outcome of Tuberculosis patients with HIV under directly observed treatment short course (DOTS) in Lubumbashi (DR Congo). J Infectious Disease Med Microbiol. 2018; 2 (2): 26-31.

Yotebieng M, Edmonds A, Lelo P, Wenzi LK, Ndjibu PT, Lusiama J, Kabuayi JP, Behets F. High completion of isoniazid preventive therapy among HIV-infected children and adults in Kinshasa,Democratic Republic of Congo. AIDS. 2015;29(15):2055-7

Misombo-Kalabela A, Nguefack-Tsague G, Kalla GM, Ze EA., Diangs K, Panda T, Kebela I, Fueza SB, Magazani N and Mbopi-Kéou FX. Facteurs de risque de la tuberculose multi-résistante dans la ville de Kinshasa en République Démocratique du Congo. Pan African Medical Journal 2016, 23(1). Doi: 10.11604/pamj.2016.23.157.6137

Mbonze NB, Tabala M, Wenzi LK, Bakoko B, Brouwer M, Creswell J, Van Rie A, Behets F, Yotebieng M. Xpert(®) MTB/RIF for smear-negative presumptive TB: impact on case notification in DR Congo. Int J Tuberc Lung Dis. 2016 ;20(2):240-6.

Kashongwe MI, Mbulula L, Umba P, Lepira FB, Kaswa M and Kashongwe ZM. Factors associated with mortality among multidrug resistant tuberculosis MDR/RR-TB patients in Democratic Republic of Congo. Journal of Tuberculosis Research 2017, 5(4), pp.276-291.

Nelson JA. Prevalence, risk factors, and outcomes of Rifampicin-sensitive and Rifampicin-resistant Tuberculosis in the South Kivu province, Democratic Republic of the Congo. Master Essay, University of Pittsburgh 2017.

Baduru JL, Ketha JK, Nzanzu AK, Maliro JBK, Mukokole JPM and Sikakulya, FK. Epidemiology of Tuberculosis and HIV Co-Infection in Butembo, Democratic Republic of the Congo. Journal of Advances in Medicine and Medical Research 2018. DOI: 10.9734/JAMMR/2018/41560

Murhula IK, Mawete F, Ofali L, Kaswa M, Bompeka FL, Ntumba JMK and Munogolo ZK. Low Detection Rate of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis in the Democratic Republic of Congo: Trend Analysis 2013-2017. Journal of Tuberculosis Research 2019, 7(4): 212-219.

Kashongwe IM, Mawete F, Mbulula L, Nsuela DJ, Losenga L, Anshambi N, Aloni M, Kaswa M, Kayembe JMN, Umba P, Lepira FB, Kashongwe ZM. Outcomes and adverse events of pre- and extensively drug-resistant tuberculosis patients in Kinshasa, Democratique Republic of the Congo: A retrospective cohort study. PLoS One. 2020;15(8):e0236264.

Bulabula ANH, Nelson JA, Musafiri EM, Machekano R, Sam-Agudu NA, Diacon AH, Shah M, Creswell J, Theron G, Warren RM, Jacobson KR, Chirambiza JP, Kalumuna D, Bisimwa BC, Katoto PDMC, Kaswa MK, Birembano FM, Kitete L, Grobusch MP, Kashongwe ZM, Nachega JB. Prevalence, Predictors, and Successful Treatment Outcomes of Xpert MTB/RIF-identified Rifampicin-resistant Tuberculosis in Post-conflict Eastern Democratic Republic of the Congo, 2012-2017: A Retrospective Province-Wide Cohort Study. Clin Infect Dis. 2019;69(8):1278-1287.

Robert BN and Many MR. Multidrug-Resistant Tuberculosis Disease in North-Kivu Province, Democratic Republic of Congo. Journal of Tuberculosis Research 2019;7(02):56.

Zogbia FY, Gbiangbada NJC, Mbembo B, et al. Epidemiological and clinical profile of tuberculosis and TB/HIV co-infection in Nord-Ubangi, Democratic Republic of the Congo. International Journal of Medical and Health Research 2019; 5(7): 111-116

Mulange N. Tanganyika: plus de 5000 cas de tuberculose enregistres en 2019.

Van Brusselen D, Simons E, Luendo T, Habarugira D, Ngowa J, Mitutso NN, Moluh Z, Steenssens M, Seguin R, Vochten H, Ngabo L, Isaakidis P, Ferlazzo G. Improving pediatric TB diagnosis in North Kivu (DR Congo), focusing on a clinical algorithm including targeted Xpert MTB/RIF on gastric aspirates. Confl Health. 2020;14:26.

Bisimwa BC, Nachega JB, Warren RM, Theron G, Metcalfe JZ, Shah M, Diacon AH, Sam-Agudu NA, Yotebieng M, Bulabula ANH, Katoto PDMC, Chirambiza JP, Nyota R, Birembano FM, Musafiri EM, Byadunia S, Bahizire E, Kaswa MK, Callens S, Kashongwe ZM. Xpert Mycobacterium tuberculosis/Rifampicin-Detected Rifampicin Resistance is a Suboptimal Surrogate for Multidrug-resistant Tuberculosis in Eastern Democratic Republic of the Congo: Diagnostic and Clinical Implications. Clin Infect Dis. 2021;73(2):e362-e370.

Bafwafwa DNMO, Lukamba RM, Tshikamba EM and Kanteng GW. Risk factors affecting mortality in children with pulmonary tuberculosis in lubumbashi, Democratic Republic of the Congo. J Lung Pulm Respir Res 2017; 4(6): 6.

Ruphine PAA, Oscar NK, Bongo GN, Désiré NL. and JeanPierre AJ. Risk Factors for Mortality in Patients with TB/HIV Co-Infection at the General Provincial Reference Hospital of Kinshasa, Democratic Republic of the Congo. Archives of Internal Medicine Research 2019; 2(1): 14-24.

Mukuku O, Mutombo AM, Kakisingi CN, Musung JM, Wembonyama SO, Luboya ON. Tuberculosis and HIV co-infection in Congolese children: risk factors of death. Pan Afr Med J. 2019;33:326.

Musafiri J, Mbayo PM, Bakaswa G, Kaswa M and Likwela JL. Séroprévalence du VIH chez les tuberculeux à Kisangani en République Démocratique du Congo. Sante Publique 2013;25(4): 483-490.

Patel MR, Nana M, Yotebieng M, Tabala M, Behets F, Van Rie A. Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection. Int J Tuberc Lung Dis. 2014;18(6):694-9.

Loukia A, Joseph SD, Zacharie K, Gertrude L, Kapay K and Patrick KK. Trends in Tuberculosis Epidemiology among Children in the Democratic Republic of Congo. Journal of Tuberculosis Research 2016; 4(04):235.

PEPFAR. Democratic Republic of the Congo Country Operational Plan (COP) 2020 Strategic Direction Summary, March 9th, 2020.

Gao J, Zheng P. Fu H. Prevalence of TB/HIV co-infection in countries except China: a systematic review and meta-analysis. PloS One. 2013;8(5):e64915.

Maimaiti R, Zhang Y, Pan K, Mijiti P, Wubili M, Musa M, Andersson R. High prevalence and low cure rate of tuberculosis among patients with HIV in Xinjiang,China. BMC Infect Dis. 2017;17(1):15.

Babatunde OI, Christiandolus EO, Bismarck EC, Emmanuel OI, Chike AC, Gabriel EI. Five years retrospective cohort analysis of treatment outcomes of TB-HIV patients at a PEPFAR/DOTS Centre in South Eastern Nigeria. African Health Sci. 2016;16(3):655–62.

Osei E, Der J, Owusu R, Kofie P, Axame WK. The burden of HIV on Tuberculosis patients in the Volta region of Ghana from 2012 to 2015: implication for Tuberculosis control. BMC Infect Dis. 2017;17(1):504.

Tesfaye B, Alebel A, Gebrie A, Zegeye A, Tesema C and Kassie B. The twin epidemics: Prevalence of TB/HIV co-infection and its associated factors in Ethiopia; A systematic review and meta-analysis. PloS one 2018; 13(10):e0203986.

NICD. The first National Prevalence survey. South Africa 2018.

Engelbrecht MC, Kigozi NG, Chikobvu P, Botha S, van Rensburg HCJ. Unsuccessful TB treatment outcomes with a focus on HIV co-infected cases: a cross-sectional retrospective record review in a high-burdened province of South Africa. BMC Health Serv Res. 2017;17(1):470.

Linguissi LS, Gwom LC, Nkenfou CN, Bates M, Petersen E, Zumla A, Ntoumi F. Health systems in the Republic of Congo: challenges and opportunities for implementing tuberculosis and HIV collaborative service, research, and training activities. Int J Infect Dis. 2017; 56:62-67






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