HIV testing during systematic screening for tuberculosis among household contacts in high-tuberculosis burden settings: A systematic review and meta-analysis

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 (110ƒ_^090 people), of which 17 (40ƒ_^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 72Aú9% (95% CI 60Aú3-83Aú9), ranging from 0% to 100%. Pooled positivity of testing was 5Aú9% (3Aú6-8Aú8) overall. Positivity was 9Aú7% (5Aú8-14Aú5; ten studies) in countries with ƒ%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

• Epidemiology and Determinants of Health
  • Epidemiology
  • Determinants of Health
• Determinants of Health
  • Health services
  • Stigma/discrimination
• Population(s)
  • General HIV- population
• Testing
  • Testing
• Co-infections
  • Tuberculosis
• Health Systems
  • Governance arrangements
  • Delivery arrangements