The effect of antiretroviral therapy adherence on viral load suppression rate among people living with HIV in Ethiopia: A systematic review and meta-analysis
5 affiliations
- 1Department of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- 2Department of Internal Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- 3Department of Public Health, College of Health Sciences, Jinka University, Jinka, Ethiopia
- 4School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- 5Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Abstract
Background: Antiretroviral therapy (ART) adherence is a key determinant of viral load suppression among people living with HIV (PLHIV). In Ethiopia, evidence on the magnitude of ART adherence and its effect on virological outcomes remains fragmented. This systematic review and meta-analysis aimed to estimate the pooled prevalence of ART adherence and viral load suppression, and to measure the association between adherence and viral suppression among PLHIV in Ethiopia. Methods: This systematic review and meta-analysis used the PRISMA checklist for systematic reviews and meta-analyses. The review protocol has been registered onPROSPERO:(CRD420251125899). PubMed, ScienceDirect, Scopus, Epistemonikos, and Google Scholar were searched. The quality of included articles has been evaluated with a Newcastle–Ottawa Scale (NOS), adapted for observational studies. A random-effects model using restricted maximum likelihood (REML) with Knapp–Hartung adjustment was used to estimate pooled prevalence and odds ratio. Heterogeneity was assessed using I2, τ2, and Cochran’s Q test. Results: A total of 39 studies were included in the final analysis. The pooled prevalence of good ART adherence was 79.4% (95% CI: 74.8%–83.4%), while the pooled viral load suppression rate was 77.5% (95% CI: 72.5%–81.8%). The pooled odds ratio showed that good ART adherence was strongly associated with viral load suppression (OR = 6.30, 95% CI: 4.84–8.19). Substantial heterogeneity was observed across studies for both adherence and viral suppression outcomes (I2 > 90%). Conclusions: ART adherence and viral load suppression among PLHIV in Ethiopia are relatively high but remain below global targets. Good adherence was significantly associated with virologic suppression, highlighting adherence as a critical modifiable factor for achieving optimal treatment outcomes. Strengthening adherence support interventions is essential to improve virological success and advance progress toward HIV epidemic control.
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BibTeX
@article{assele2026effect,
title = {{The effect of antiretroviral therapy adherence on viral load suppression rate among people living with HIV in Ethiopia: A systematic review and meta-analysis}},
author = {Desalegn Dawit Assele and Yitayew Ewnetu Mohammed and Abera Gezume Ganta and Tadele Dana Darebo and Sileshi Demelash Sasie},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358352},
url = {https://doi.org/10.1371/journal.pone.0358352},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The effect of antiretroviral therapy adherence on viral load suppression rate among people living with HIV in Ethiopia: A systematic review and meta-analysis
AU - Desalegn Dawit Assele
AU - Yitayew Ewnetu Mohammed
AU - Abera Gezume Ganta
AU - Tadele Dana Darebo
AU - Sileshi Demelash Sasie
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0358352
UR - https://doi.org/10.1371/journal.pone.0358352
AB - Background: Antiretroviral therapy (ART) adherence is a key determinant of viral load suppression among people living with HIV (PLHIV). In Ethiopia, evidence on the magnitude of ART adherence and its effect on virological outcomes remains fragmented. This systematic review and meta-analysis aimed to estimate the pooled prevalence of ART adherence and viral load suppression, and to measure the association between adherence and viral suppression among PLHIV in Ethiopia. Methods: This systematic review and meta-analysis used the PRISMA checklist for systematic reviews and meta-analyses. The review protocol has been registered onPROSPERO:(CRD420251125899). PubMed, ScienceDirect, Scopus, Epistemonikos, and Google Scholar were searched. The quality of included articles has been evaluated with a Newcastle–Ottawa Scale (NOS), adapted for observational studies. A random-effects model using restricted maximum likelihood (REML) with Knapp–Hartung adjustment was used to estimate pooled prevalence and odds ratio. Heterogeneity was assessed using I2, τ2, and Cochran’s Q test. Results: A total of 39 studies were included in the final analysis. The pooled prevalence of good ART adherence was 79.4% (95% CI: 74.8%–83.4%), while the pooled viral load suppression rate was 77.5% (95% CI: 72.5%–81.8%). The pooled odds ratio showed that good ART adherence was strongly associated with viral load suppression (OR = 6.30, 95% CI: 4.84–8.19). Substantial heterogeneity was observed across studies for both adherence and viral suppression outcomes (I2 > 90%). Conclusions: ART adherence and viral load suppression among PLHIV in Ethiopia are relatively high but remain below global targets. Good adherence was significantly associated with virologic suppression, highlighting adherence as a critical modifiable factor for achieving optimal treatment outcomes. Strengthening adherence support interventions is essential to improve virological success and advance progress toward HIV epidemic control.
SN - 1932-6203
ER -