Global and regional trends in multidrug- or rifampicin-resistant tuberculosis, 2000-2024 with forecasts to 2030: a systematic review and meta-analysis.

OBJECTIVES

Tuberculosis remains the world’s leading infectious killer, with 8.2 million new cases reported in 2023. Multidrug- or rifampicin-resistant TB (MDR/RR-TB) continues to drive disproportionate mortality worldwide. To analyze trends in MDR/RR-TB prevalence across World Health Organization (WHO) regions from 2000 to 2024, with Forecasts to 2030.

METHODS

We conducted a systematic review and meta-analysis to assess MDR/RR-TB prevalence among tuberculosis patients. Five databases (PubMed, EBSCO, SCOPUS, Web of Science, Google Scholar) were searched for studies published between 01/2010 and 06/2025. Pooled prevalence was estimated using a random-effects model, with heterogeneity quantified via I2 statistics. Subgroup and sensitivity analyses stratified results by age, sex, WHO region, study period, sample size, and TB burden.

RESULTS

Our meta-analysis included 102 studies (4.12 million cases; 66.1% male, weighted mean age 39.47 years [SD 5.7]) across 52 countries. Global pooled MDR-TB prevalence declined significantly from 14.4% (95% CI 9.0–19.8) in 2000–2009 to 2.6% (2.3–2.9) in 2020–2024. Africa reported the highest regional burden: prevalence fell from 31.0% (17.3–44.6) to 4.9% (2.8–7.1) over the same period, exceeding other WHO regions in 2020–2024 (Americas: 1.3%; Europe: 1.4%; South-East Asia: 2.6%). Globally, prevalence was higher among males (12.0%, 10.8–13.3) than females (9.7%, 8.6–10.7) and markedly elevated in previously treated patients (19.8%, 18.2–21.4) versus new cases (5.9%, 5.2–6.6). Africa demonstrated distinct epidemiology: the male-female gap narrowed (males: 16.9% [13.5–20.4]; females: 16.3% [12.7–20.0]), and patients aged < 40 years faced disproportionately high prevalence (16.9% [13.8–20.0] vs. global: 4.9% [4.1–5.7]). Previously treated African patients had the highest burden (26.2%, 19.6–32.8), exceeding the global average (18.2%, 16.4–19.9). The pooled prevalence of MDR/RR-TB among HIV co-infected patients in Africa (22.2% [95% CI 17.2–27.1]) is 2.3-fold higher than the global average excluding Africa (9.7% [8.5–10.9]).

CONCLUSIONS

While global MDR/RR-TB prevalence has significantly declined, Africa continues to bear a disproportionate burden, particularly among retreatment cases, young adults, and HIV-positive patients. These findings highlight the urgent need for targeted interventions in high-burden populations and regions. CLINICAL TRIAL NUMBER: not applicable.