Impact of COVID-19 on TB and HIV/AIDS severity in low- and middle-income countries: a systematic review

Abstract

Background Beyond its profound health, social, and economic consequences, COVID-19 poses a serious threat to the management of tuberculosis (TB) and HIV/AIDS. However, empirical evidence remains limited. This study evaluates the impact of the COVID-19 pandemic on TB and HIV/AIDS service delivery across low- and middle-income countries. Methods This systematic review protocol was registered with PROSPERO (CRD42021266242). Following PRISMA guidelines, we searched databases—including PubMed, ClinicalTrials.gov, and CINAHL—for studies on TB and HIV/AIDS services published between January 1, 2019, and January 8, 2024. A random-effects model calculated pooled relative risks to evaluate overall TB/HIV outcome severity, and subgroup analyses were performed to evaluate regional risk variations. Results In low- and middle-income countries, non-TB patients with COVID-19 had a lower risk of severe outcomes compared to those with TB (pooled OR = 0.71, 95% CI: 0.60–0.83). Conversely, HIV patients with COVID-19 faced an increased risk of severe disease (pooled RR = 1.78, 95% CI: 1.45–2.19). By region, the pooled OR for severe COVID-19 in patients with TB was 0.83 (95% CI: 0.63–1.08) in Asia and 0.64 (95% CI: 0.51–0.79) in Africa. For HIV patients with COVID-19, the risk of severe disease was 1.73 (95% CI: 1.38–2.18) in Asia and 1.98 (95% CI: 1.26–3.10) in Africa. Conclusion In low- and middle-income countries, COVID-19 patients with underlying conditions were significantly more likely to experience severe outcomes than those without comorbidities. Furthermore, the pandemic severely disrupted fragile health systems in these regions, exacerbating the burden of tuberculosis and HIV/AIDS.