Prevalence of HIV among healthcare workers in the post-HAART era - a systematic review and meta-analysis.

Background: Healthcare workers (HCWs) are at potential risk of HIV infection through occupational exposure. However, with the advent of highly active antiretroviral therapy (HAART), universal precautions, and post-exposure prophylaxis, the global risk profile has changed.

Objective: This study synthesized data on HIV prevalence among HCWs worldwide to assess current epidemiological patterns and to evaluate regional heterogeneity.

Methods: Following PRISMA guidelines, we systematically searched PubMed, Scopus, and the Cochrane Library for studies reporting serological evidence of HIV infection among HCWs published between 1996 and September 2025, corresponding to the post-HAART era. Data were extracted on study design, sample size, and the number of HIV-positive cases. Prevalence estimates were compared with internal control groups or with national background prevalence data obtained from UNAIDS. Methodological quality was assessed using the Westermann score. Random-effects meta-analyses were performed to estimate pooled HIV prevalence by WHO region.

Results: Of 220 studies identified, 14 from 12 countries met inclusion criteria. Across 7,705 HCWs tested, the overall pooled HIV prevalence was 0.68% (95% CI 0.19-2.46) with extreme heterogeneity (I²=94.3%, τ²=5.003). Whilst the pooled prevalence among HCWs in Sub-Saharan Africa was 7.1% (95 % CI 3.3-12.7), all other regions-Europe, Latin America, and the Eastern Mediterranean-showed pooled prevalences of 0.0% (95% CI 0.0-3.7), with no HIV-positive HCWs detected.

Conclusions: HIV infection among HCWs is now exceedingly rare worldwide, with elevated prevalence confined to high-endemic African regions as a regional dichotomy. The findings indicate that HIV infection in HCWs is primarily driven by community transmission rather than occupational exposure and highlight the success of infection-control policies and ART expansion in eliminating workplace transmission. Sustained surveillance and equitable access to protective equipment and post-exposure prophylaxis remain essential to preserve this major occupational-health achievement.