Virological suppression rate and its predictors among HIV/AIDS patients on antiretroviral therapy before and during the COVID-19 pandemic in Ethiopia: Systematic review and meta-analysis

Abstract Background Achieving viral load suppression is crucial for the prevention of complications and deaths related to HIV infection. Ethiopia has embraced the worldwide 90-90-90 target, but there is no national representative information regarding virological suppression. Therefore, this review aims to determine the pooled virological suppression rate and identify the pooled effect of contributing factors of viral suppression for HIV-positive patients on antiretroviral therapy in Ethiopia. Method We systematically searched websites and databases, including online repositories, to obtain primary studies. We assessed the quality of the included articles using the Newcastle‒Ottawa Scale appraisal checklist by two reviewers. Publication bias was checked using Egger’s regression test, the heterogeneity of the studies was assessed using I2 statistics and Q statistics, and sensitivity analysis was performed to identify any outlier results in the included studies. The Der Simonian Laird random-effects model was used to estimate the overall proportion of viral suppression, and STATA 17 statistical software was used for all types of analysis. Result A total of 21 eligible articles were used for this quantitative synthesis. The overall pooled virological suppression was 71% (95% CI: 64%, 77%). The pooled effects of poor adherence to ART (AOR = 0.33; 95% CI: 0.28, 0.40), body mass index (18.5–24.9 kg/m2) (AOR = 1.8; 95% CI: 1.37, 2.36), disclosure AOR = 1.41; 95% CI: 1.05, 1.89), absence of opportunistic infection (AOR = 1.68; 95% CI: 1.43, 1.97), and high baseline viral load (AOR = 0.65; 95% CI: 0.52, 0.81) were identified as significant predictors of viral suppression. Conclusion The overall pooled percentage of virological suppression was low compared with the global target of viral suppression. Poor adherence, normal body mass index, disclosure, absence of opportunistic infection and high viral load were contributing factors of viral suppression in Ethiopia. Responsible stakeholders should maximize their effort to achieve the global target of virological suppression by addressing significant predictors. Prospero registration number and google link: CRD42023434248.