BACKGROUND:Tuberculosis household contacts are at elevated risk of HIV, and systematic screening for tuberculosis is an opportunity for people to know their status. We aimed to assess the coverage and positivity of HIV testing during household systematic screening for tuberculosis. METHODS:For this systematic review and meta-analysis (PROSPERO: CRD42024471979), we searched MEDLINE, Embase, Global Health, and Africa Wide databases from Jan 1, 2000, to June 24, 2025. The primary analysis population was household contacts of people with tuberculosis without known HIV. Studies were included if HIV testing was offered to household contacts, and in the primary analysis if people known to be living with HIV were excluded from the population eligible for testing. We extracted or derived coverage (proportion of people eligible for testing who received an HIV test) and positivity (proportion of people tested with a positive result) and calculated pooled proportions using random effects meta-analysis. We narratively summarised themes from qualitative reports. Meta-regression examined the association of national HIV prevalence, time period, and participant age, with coverage and positivity of HIV testing. FINDINGS:Searches identified 31 quantitative studies (110 090 people), of which 17 (40 407 people) were included in primary analyses. Seven qualitative studies reported community or provider perspectives. The pooled proportion of eligible household contacts tested for HIV was 72·9% (95% CI 60·3-83·9), ranging from 0% to 100%. Pooled positivity of testing was 5·9% (3·6-8·8) overall. Positivity was 9·7% (5·8-14·5; ten studies) in countries with ≥10% national adult HIV prevalence. Qualitative studies highlighted context-dependent facilitators and barriers of household contacts' capability, opportunity, and motivations to engage with HIV testing. INTERPRETATION:Few studies have evaluated HIV testing for tuberculosis household contacts. Coverage of testing was reasonable but varied substantially across studies. Positivity of testing was high. Further research is needed to understand and optimise acceptability and ensure feasibility of HIV testing within screening of tuberculosis among household contacts, and tuberculosis-HIV programmes in high HIV-incidence settings should consider monitoring implementation of HIV within routine tuberculosis household contact screening. FUNDING:National Institute for Health and Care Research and Wellcome Trust.
Chronic kidney disease (CKD) is often complicated by disorders in multiple body systems, associated with higher mortality and morbidity. Young people living with HIV (YPLHIV) have an increased risk of multisystem chronic comorbidities. However, there are few data describing comorbidities associated with CKD among YPLHIV. We conducted a case-control study in seven ART clinics in Kampala, Uganda. Cases were YPLHIV (aged 10–24 years) diagnosed with CKD and controls were those without CKD. We collected data on demographic and clinical factors: HIV viral load, CD4 T cell count, blood pressure, fasting glucose levels, anaemia, electrolytes, parathyroid hormone, and cognitive impairment. We summarized the demographic and clinical factors and used logistic regression to estimate odds ratios (OR) and 95
Africa's older population is rapidly increasing, necessitating the development of healthy aging interventions. Nutrition is a key component of healthy aging. Evidence synthesis on nutrition outcomes of older adults in Africa is emerging but a synthesis on interventions is lacking. The aim was to synthesize evidence from reviews on older people in Africa to determine the prevalence of nutrition outcomes and associated factors (phase 1) and implemented interventions (phase 2). Literature searches using Medline, EMBASE, Web of Science, African Index Medicus, and African Journals Online were conducted up to May 9, 2024. After screening, 25 reviews (for phase 1) and 22 articles (for phase 2) were selected for inclusion. Most reviews (n = 16; 64%) were systematic, with 8 having a meta-analysis, and published between 2020 and 2023 (n = 20; 80%). The pooled prevalence of malnutrition (being underweight) was 21% (evidence from 5 reviews), 26% for sarcopenia (1 review), 27% for obesity (3 reviews), 32% for constipation (1 review), 39% for food insecurity (2 reviews), 49% for dental caries (1 review), and 64% for vitamin D insufficiency and deficiency (2 reviews). The 22 articles on nutritional interventions represented only 6 countries, mostly South Africa (64%; 14/22), evaluated using randomized trials (n = 10; 45%) and educational interventions (n = 10; 45%). Reported interventions were not typically underpinned by supporting systematic reviews or a contextual evidence base, did not account for the minimally important clinical difference, lacked evidence of community engagement, and were not reported transparently. Nutritional research is needed on older adults outside of South Africa and beyond malnutrition. Future nutritional interventions (ideally, multicomponent) for older people in Africa should consider targeting the multiple nutritional and practical needs (eg, dietary counseling, supplementation) of older adults. Intervention development should be evidence-based, include engagement with older people, and follow complete and transparent reporting.
Tuberculosis persists as the world's deadliest infectious disease, despite improved diagnostics and effective treatment. The tuberculogenic environment describes the sum of influences, vulnerabilities, policies, life conditions, and health factors that sustain the tuberculosis pandemic in vulnerable communities. The persistence of these environments is attributable to challenges upstream of the health system, involving sectors such as trade, taxation, finance, agriculture, employment, social services, and education. The availability, affordability, access, and acceptability of safe infrastructure (including housing), nutritious foods, protection against harmful consumption (tobacco, alcohol, sugar, etc), and adequately resourced health services are all linked to tuberculosis risk. Yet people affected by tuberculosis and national tuberculosis control programmes continue to bear almost the sole responsibility for a problem that is largely beyond their control. Reframing tuberculosis through the lens of complex systems science highlights the array of decision makers who, by action or inaction, have a shared responsibility to end tuberculosis as a global pandemic.
BACKGROUND:Hypertension and diabetes prevalence are increasing across Africa. We investigated the prevalence, associated factors, achievement of stages within the care cascade (diagnosis, treatment, control), and health-related quality of life (HRQoL) in three countries in Africa. METHODS AND FINDINGS:This cross-sectional study recruited adults aged ≥40 years in five settings: rural (n = 1,052) and urban (n = 1,218) The Gambia, rural (n = 948) and urban (n = 968) South Africa (SA), and urban (n = 1,110) Zimbabwe between 2022 and 2024. Data were collected using researcher-administered questionnaires and assessments. Hypertension and diabetes were defined using self-reported diagnosis, medication use, and blood pressure and glucose measurements. HRQoL was assessed using EuroQol-5 Dimension 5 Level questionnaire, with a minimally important difference (MID) defined as half a standard deviation (SD). Diabetes complications included neuropathy, cardiovascular disease, and kidney disease. Associations between hypertension and diabetes and risk factors were assessed using study site, age, sex, educational attainment, and wealth index-adjusted Generalised Linear Mixed Effects Models. Associations between care cascade stages and HRQoL were assessed using linear models. Analysis included 5,296 adults, 53% female, and 52% age ≥60 years. Overall hypertension prevalence was 55.6% (95% confidence intervals [CI] 54.2%-56.9%); ranging from 39.6% (95% CI: 36.7-42.7) in rural The Gambia to 66.9% (64.1-69.7) in urban Zimbabwe. Overall, diabetes prevalence was 14.0% (13.1%-15.0%), ranging from 9.2% (7.6-11.0) in urban Zimbabwe to 19.4% (16.9-22.1) in rural SA. Both overweight and obesity, compared to normal weight, were associated with higher odds of hypertension (adjusted odds ratios: 1.73 (95% CI [1.47, 2.03]; p < 0.001) and 2.08 (95% CI [1.74, 2.49]; p < 0.001), respectively and diabetes (1.53 (95% CI [1.22, 1.91]; p < 0.001) and 2.12 (95% CI [1.67, 2.69); p < 0.001), respectively. The proportion with treated and controlled hypertension was 31.0% (913/2944), with 27.2% (800/2944) undiagnosed, and 26.0% (766/2944) treated but uncontrolled. Overall, 21.9% (161/735) had treated and controlled diabetes, whilst 49.7% (365/735) were undiagnosed, and 15.4% (113/735) were diagnosed and untreated. Underdiagnosis and inadequate treatment and control of both diseases were more common in men and in The Gambia. Overall, hypertension targets of 80-80-80% in diagnosis, treatment, and control were 72.8%(2144/2944), 78.3% (1679/2144), and 54.4% (913/1679), respectively. Diabetes targets of 80-80-80-60% in diagnosis, glucose control, hypertension control, and statin use were 50.8%(377/742), 65.7% (243/370), 60.4% (224/371), and 17.8% (67/377), respectively. For both disease targets, South Africa performed better than The Gambia and Zimbabwe. The overall mean±SD HRQoL utility score was 0.829 ± 0.107 (MID = 0.054). Compared to being nonhypertensive, having diagnosed and untreated hypertension was associated with a -0.07 (95%CI [-0.05, -0.08]; p < 0.001) lower HRQoL utility score. Compared to being nondiabetic, having treated and controlled diabetes was associated with lower HRQoL: -0.07 (95% CI [-0.01, -0.13]; p = 0.028) in The Gambia and -0.08 (95% CI [-0.03, -0.12]; p < 0.001) in Zimbabwe. Having ≥1 complication was associated with lower HRQoL: -0.04 (95% CI [-0.03, - 0.05]; p < 0.001). Study limitations are the cross-sectional design and reliance on single measurements of blood pressure and glucose concentrations. CONCLUSIONS:The high prevalence of hypertension and diabetes in mid-age and older adults in rural and urban Africa necessitates urgent diagnostic, preventive, and control interventions. This can include interventions targeted at obesity, screening of all adults aged ≥40 years, prompt and optimal treatment for those diagnosed, and ongoing monitoring to limit complications.
