Uptake and disparities in tuberculosis screening using urine-lipoarabinomannan among patients with advanced human immunodeficiency virus-disease in Africa: A systematic review

doi:10.5501/wjv.v14.i3.107214

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World Journal of Virology

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Systematic Reviews

World J Virol. Sep 25, 2025; 14(3): 107214
Published online Sep 25, 2025. doi: 10.5501/wjv.v14.i3.107214

Uptake and disparities in tuberculosis screening using urine-lipoarabinomannan among patients with advanced human immunodeficiency virus-disease in Africa: A systematic review

Lynn Moshi, Hafidha Mhando Bakari, Jackline Vicent Mbishi, Zuhura Mbwana Ally, Mariam Salim Mbwana, Haji Mbwana Ally, Rahma Musoke, Swalehe Mustafa Salim, Maximillian Francis Karia, Leticia Francis Karia, Hassan Fredrick Fussi, Aboubakar Omar Mustafa, Ibrahim Ahmed El-lmam, Habib Omari Ramadhani

Lynn Moshi, Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar es Salaam 14112, Tanzania

Hafidha Mhando Bakari, Department of Literature, Communication and Publishing, University of Dar es Salaam, Dar es Salaam 16103, Tanzania

Jackline Vicent Mbishi, Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11102, Tanzania

Zuhura Mbwana Ally, Hassan Fredrick Fussi, Department of Medicine, District Hospital, Tanga 21628, Tanzania

Mariam Salim Mbwana, Department of Medicine, Primary Health Care Institute, Iringa 51108, Tanzania

Haji Mbwana Ally, Department of Medicine, Kilimanjaro Christian Medical Center, Moshi 25116, Kilimanjaro, Tanzania

Rahma Musoke, Department of Research, Water Mission, Dar es Salaam 14112, Tanzania

Swalehe Mustafa Salim, Department of Research, Canada Youth Group, Dar es Salaam 15103, Tanzania

Maximillian Francis Karia, Department of Research, The Greenfield School at Wilson, North Carolina, Wilson, NC 27893, United States

Leticia Francis Karia, Department of Research, Appalachian State University, Boone, NC 28608, United States

Aboubakar Omar Mustafa, Department of Pharmacy, Tanga Regional Referral Hospital, Tanga 21101, Tanzania

Ibrahim Ahmed El-lmam, Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD 21201, United States

Habib Omari Ramadhani, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, United States

Co-first authors: Lynn Moshi and Hafidha Mhando Bakari.

Author contributions: Moshi L, Bakari HM, and Ramadhani HO contributed to conceptualization; Ally ZM, Moshi L, Musoke R, Mbwana MS, Mustafa AO, Ally HM, and Ramadhani HO contributed to data curation; Mbishi JV, Ally HM, and Ramadhani HO contributed to formal analysis; Mbishi JV, Ally HM, Bakari HM, Fussi HF, Ibrahim AE, and Ramadhani HO contributed to methodology; Fussi HF and Ramadhani HO; Ally ZM, Moshi L, Musoke R, Mbwana MS, Mustafa AO and Ramadhani HO contributed to validation; Mbishi JV, Karia MF contributed to writing original draft Bakari HM and Moshi L contributed to visualization; Bakari HM, Mbishi JV, Ally ZM, Mbwana MS, Moshi L, Musoke R, Salim SM, Karia MF, Karia LF, Fussi HF, Mustafa AO, Ibrahim AE and Ramadhani HO contributed to writing review and editing. All authors reviewed this manuscript, provided feedback, and approved the manuscript in its final form.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Statement-checklist of items, and the manuscript was prepared and revised accordingly.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Habib Omari Ramadhani, Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, United States. homari@ihv.umaryland.edu

Received: March 18, 2025
Revised: April 21, 2025
Accepted: June 13, 2025
Published online: September 25, 2025
Processing time: 191 Days and 18 Hours

Abstract

BACKGROUND

Due to low bacteria count and high likelihood of having extrapulmonary tuberculosis (TB) among patients with advanced human immunodeficiency virus (HIV) disease, the World Health Organization (WHO) recommended the use of urine lateral flow urine lipoarabinomannan (LF-LAM) or sputum-Xpert to screen for TB.

AIM

To estimate pooled prevalence of TB screening uptake, TB diagnosis, TB treatment initiation and mortality among patients with advanced HIV disease in Africa.

METHODS

PubMed, Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024. TB screening uptake was defined as percentage of patients with advanced HIV disease (CD4 ≤ 200 cells/mm³ or WHO stage III/IV) who tested for TB. Using random effects models, we computed the pooled estimate of TB screening uptake, TB prevalence, TB treatment initiation and mortality and their corresponding 95%CIs. Stratified analysis to compare uptake of TB testing and TB prevalence between children vs adults and multisite vs single site studies was performed.

RESULTS

A total of nineteen studies with 16065 people with advanced HIV disease were analyzed. The pooled prevalence of TB screening uptake was 64.6% (95%CI: 49.2–80.1). The pooled prevalence of TB was 29.4% (95%CI: 22.0–36.8), and TB treatment initiation was 77.9% (95%CI: 63.9–91.8), and mortality was 19.5% (95%CI: 8.9–30.0). The pooled prevalence of TB testing uptake was significantly lower among children compared to adults (28.2% vs 66.4%, P = 0.003) and lower for multi-sites compared to single site studies (58.8% vs 82.9%, P = 0.002). The pooled prevalence of TB was significantly lower among children compared to adults (24.2% vs 27.6%, P = 0.012) and higher among studies that involved multi vs single sites (30.0% vs 21.9%, P = 0.001).

CONCLUSION

Four in ten people with advanced HIV disease were not screened for TB as recommended by the WHO, indicating significant gaps in identifying patients with TB. Excluding patients with evidence of TB is critical to avoid exposing them to subtherapeutic levels of anti TB treatment.

Keywords: Tuberculosis testing uptake; Urine lateral flow lipoarabinomannan; Tuberculosis prevalence; Mortality; Africa

Core Tip: Despite its benefit, the utility of lateral flow urine lipoarabinomannan assays in the diagnosis of tuberculosis (TB) among patients with advanced human immunodeficiency virus (HIV) disease in Africa is low. This systematic review analyzed 16055 participants with advanced HIV from nineteen studies involving thirteen countries in Africa. Of the participants eligible to test for TB using lateral flow urine lipoarabinomannan (LF-LAM), only 63% tested with uptake being lower among children compared to adults. Among those diagnosed with TB, 22% died. Nearly four in ten people with advanced HIV disease in Africa tested for TB using LF-LAM per the World Health Organization recommendations, indicating missed opportunity to diagnose TB among patients at high risk of having TB.