Prevalence of genital and anorectal chlamydia trachomatis in Kenya by risk groups: a systematic review and meta-analysis

The epidemiology of Chlamydia trachomatis (CT) in Kenya is not well understood. We conducted a systematic review and meta-analysis of CT prevalence using PubMed, Embase, and Kenyan databases (Jan 2000-June 2024). Included studies had laboratory-confirmed CT and were peer-reviewed. Populations were categorized by sex/gender and STI vulnerability. A random-effects model was used to account for heterogeneity. Of 198 records, 51 studies (32,559 participants) were included. CT prevalence was reported for 18 studies on males, 36 on females, and four on the general population. Pooled prevalence was 5.8% (95% CI 4.6-7.4) with high heterogeneity. The highest prevalence was among general population females > 25 years (14.8%), while at risk males > 25 had the lowest (0.1%). Studies spanned 13 regions, with Nairobi, Kisumu, and Mombasa most represented. CT prevalence in Kenya aligns with WHO estimates for Africa. High prevalence among general population women > 25 challenges traditional STI risk assumptions. Importantly, the association between HIV and CT was not uniform across populations, suggesting that relying solely on HIV-focused platforms may overlook groups with a substantial CT burden. Addressing diagnostic gaps, urban-rural disparities, and links with HIV care is critical.Trial registration CRD42024567235.