Background: Syphilis is a curable sexually transmitted infection which, untreated, is associated with significant morbidity and mortality. In people living with HIV (PLWH), syphilis carries greater risks of disease progression. We estimated syphilis prevalence among PLWH in the general population in sub-Saharan Africa and compared prevalence among PLWH and without HIV.

Methods: We searched for studies published 1st January 2011 to 28th March 2022 reporting syphilis prevalence among PLWH in sub-Saharan Africa (PROSPERO#: CRD42020167328). We excluded studies in high-risk subpopulations. We estimated pooled syphilis prevalence among PLWH using random effects modelling and compared prevalence to people without HIV when included in the same study. We examined influences of region, study setting, and test type in subgroup analyses.

Results: We identified 926 studies; 53 were included in the meta-analysis. Pooled syphilis prevalence among PLWH was 7.3% (95% CI: 6.3-8.5%). Prevalence differed by region: 3.1% (95% CI: 2.2-4.0%) in Southern, 5.5% (95% CI: 2.3-9.3%) in West/Central, and 10.5% (95% CI: 8.0-13.1%) in Eastern Africa. Prevalence also differed by study setting: 13.8% (95% CI 5.7-23.0%) in SRH/STI care, 8.7% (95% CI 5.0-12.8%) in HIV care, 7.1% (95% CI 5.8-8.5%) in antenatal care and 3.8% (95% CI 2.0-5.8%) household/community-based settings. Syphilis prevalence was higher among PLWH than without HIV (RR: 3.5, 95% CI: 2.8-4.5).

Conclusions: Syphilis is highly prevalent among PLWH in sub-Saharan Africa and is more common among PLWH than without HIV. Integration of syphilis screening and management into HIV care may reduce complications of HIV-syphilis co-infection among PLWH in sub-Saharan Africa.