HIV-Tuberculosis Co-Infection Among Immigrants and Refugees in the United States: An Integrative Review

HIV-tuberculosis (HIV-TB) co-infection remains a leading cause of morbidity and mortality among people living with HIV and disproportionately affects immigrant and refugee communities in the United States. While antiretroviral therapy has improved HIV outcomes, cultural, social, and psychological barriers hinder timely diagnosis and sustained HIV-TB co-infection care in these populations. This integrative review aims to synthesize evidence on cultural, social, and psychological factors influencing access to diagnosis, treatment, and management of HIV, TB, and HIV-TB co-infection among immigrant and refugee populations in the United States. This study is an integrative review guided by Whittemore and Knafl's framework. We conducted a systematic search of PubMed, Scopus, and CINAHL for peer-reviewed, mixed-methods, quantitative, qualitative, and review articles published in English between 2015 and 2025. After duplications were removed and dual screening of 107 retrieved records, 16 articles met inclusion criteria for this study. Findings were thematically categorized and synthesized. The themes generated were placed into three main categories: cultural factors including stigma and misperceptions about disease transmission; social factors such as limited healthcare access, lack of insurance, and socioeconomic marginalization; and psychological factors including fear of deportation, trauma, and mistrust of healthcare systems. Addressing HIV-TB co-infection in immigrant and refugee populations requires holistic, trauma-informed, and community-engaged strategies that integrate mental health support, culturally and linguistically tailored education, and policy reforms to remove structural obstacles. Future research should employ culturally validated measures to co-create sustainable interventions and advance health equity.