Prevalence of HIV in slums area: a systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Human Immunodeficiency Virus (HIV) remains a significant global health burden, particularly affecting vulnerable populations residing in slum areas which is characterized by overcrowding, poverty, and limited access to healthcare services, create an environment conducive to the transmission and spread of HIV. Despite the recognition of this issue, there is a lack of comprehensive understanding regarding the prevalence of HIV in slums. The aim of this study was to systematically synthesize the existing global evidence on HIV prevalence in slum populations. METHODS: A rigorous systematic literature review was conducted by searching multiple electronic databases, including Medline via PubMed, Scopus, Embase, Web of Sciences, and Directory of Open Access Journals (DOAJ), covering the period from January 1, 1990, to March 31, 2023. The quality and risk of bias for each included study were assessed using the Newcastle-Ottawa Scale. The pooled prevalence with its corresponding 95% confidence interval (CI) was calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. The degree of heterogeneity among the studies was evaluated using the I2 test. Publication bias was also assessed using Egger's test. Additionally, subgroup analysis was performed to explore potential factors contributing to the observed heterogeneity. RESULTS: A systematic examination of the relevant literature resulted in the inclusion of a total of 22 studies for the purpose of this meta-analysis. These studies collectively assessed a sizable cohort consisting of 52,802 participants. Utilizing a random-effects model, an estimation of the overall prevalence of HIV in the slum area was determined to be 10% (95% CI 7-13%). Further delineation through subgroup analysis based on the gender revealed a higher prevalence of HIV among women, standing at 13% (95% CI 8-19%, 18 studies I2 = 98%), as opposed to men, where the prevalence was found to be 8% (95% CI 6-12%, 16 studies I2 = 95%). A geographical breakdown of the included studies revealed that Africa exhibited the highest prevalence, with a figure of 11% (95% CI 9-13%, 18 studies I2 = 98%). Subsequently, studies conducted in the American continent reported a prevalence of 9% (95% CI 7-11%, 2 studies I2 = 57%). The Asian continent, on the other hand, displayed the lowest prevalence of 1% (95% CI 0-3%, 2 studies I2 = 94%). Notably, studies employing rapid tests indicated a prevalence of 13% (95% CI 9-17%, 6 studies I2 = 94%), while those relying on self-reported data reported a lower prevalence of 8% (95% CI 5-11%, 6 studies I2 = 99%). Moreover, studies utilizing ELISA reported a prevalence of 9% (95% CI 6-12%, 10 studies I2 = 96%). Finally, it was determined that studies conducted in upper-middle-income countries reported a higher prevalence of 20% (95% CI 16-24%, 5 studies I2 = 45%), whereas studies conducted in lower- and middle-income countries reported a prevalence of 8% (95% CI 6-10%, 12 studies I2 = 98%). CONCLUSION: The current study elucidates the troublingly high prevalence of HIV infection within slums area. Also, this finding underscores the urgent necessity for targeted and tailored interventions specifically aimed at curtailing the spread of HIV within slums. Policymakers must take cognizance of these results and devote their efforts towards the implementation of effective strategies to mitigate gender disparities, address poverty alleviation, and empower the inhabitants of these marginalized areas.