Virologic failure and its determinants among HIV patients progress towards the third 95% global target in Ethiopia: a systematic review and meta-analysis

The Joint United Nations Program on HIV/AIDS endorsed a new striving 95–95-95 target to end the AIDS epidemic by the end of 2030. This initiative has been implemented by many countries, including Ethiopia, but achieving it requires paramount effort. The purpose of this study was to determine the pooled virologic failure and its determinants using available evidence in Ethiopia. We searched available evidence on virologic failure from databases PubMed, Hinari, Cochrane, ScienceDirect, Google Scholar, and other search engines until May 30, 2024. Two authors independently searched articles and extracted them using a Microsoft Excel spreadsheet format. The quality of the studies was evaluated using the Newcastle Ottawa Scale. Heterogeneity among included studies was assessed using the Higgins I2 test statistic. The pooled estimates and its determinants were assessed with a random-effects model using Stata/MP version 17. We searched 14,493 relevant records from different databases, and after excluding duplicates, 63 articles were included in this study. The pooled virologic failure was 17.30 (95% CI: 14.57, 20.03, I2 = 99.6). Subgroup analysis indicated that virologic failure prevalence varied by region: it was highest in Southern Ethiopia (26.96%), followed by Oromia region (17.81%). Additional subgroup findings included higher failure in studies conducted after the initiative (18.73%) and among patients under enhanced adherence counseling (43.77%). Poor adherence [OR: 8.10 (95% CI: 4.41, 14.85)], low CD4 count [OR: 2.60 (95% CI: 1.34, 4.99)], advanced WHO clinical staging [OR: 3.99 (95% CI: 2.20, 7.25)], opportunistic infection [OR: 4.91 (95% CI: 2.66, 9.04)], active tuberculosis [OR: 4.54 (95% CI: 1.80, 11.45)], use of cotrimoxazole [OR: 3.13 (95% CI: 1.23, 7.99)], substance use [OR: 4.88 (95% CI: 1.35, 17.62)], and rural residence [OR: 2.88 (95% CI: 1.41, 5.87)] were identified as determinants. Virologic failure was far away from the third 95% target in Ethiopia, with an expected 86% viral suppression. Despite the escalating viral load testing sites and implementation of different programs, the achievement is unacceptably high nationally. This requires innovative strategies, region-specific interventions, and tremendous efforts to meet the global goal by the end of 2030.