Dietary diversity practice among HIV-positive adults in Ethiopia and its associated factors: a systematic review and meta-analysis

Adequate nutrition is an essential component of care and support for people living with HIV. Dietary diversity is a key indicator of diet quality and nutritional adequacy; however, evidence regarding dietary diversity practices among adults living with HIV in Ethiopia remains fragmented. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of dietary diversity and identify its associated factors among HIV-positive adults in Ethiopia. A systematic review and meta-analysis was conducted following the PRSIMA 2020 guideline. Electronic databases, including PubMed/MEDLINE, EMBASE, Web of Science, and ScienceDirect, were searched. Observational studies reporting dietary diversity and/or its determinants among HIV-positive adults in Ethiopia were included. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tool. Stata version 17 software was used for the data analysis. Cochran’s Q statistic with inverse variance (I2) and Egger’s test were used to assess the presence of heterogeneity and publication bias, respectively. A random-effects model was used to estimate pooled prevalence and pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Nineteen studies involving 6,963 HIV-positive adults were included. The pooled prevalence of adequate dietary diversity was 43.87% (95% CI: 32.53%, 55.20%). Being unable to read and write (OR: 0.68; 95% CI: 0.46, 0.85), WHO clinical stage I (OR: 1.97; 95% CI: 1.38, 2.82), cotrimoxazole prophylaxis intake (OR: 0.62; 95% CI: 0.47, 0.84) and receipt of nutritional counseling (OR: 4.17; 95% CI: 1.29, 13.42) were significantly associated with adequate dietary diversity. Adequate dietary diversity remains suboptimal among adults living with HIV in Ethiopia. Therefore, it’s essential for healthcare practitioners to strengthen nutritional counseling as an integral component of comprehensive care for people living with HIV and to provide particular attention for those taking cotrimoxazole prophylaxis. Furthermore, continuous support for HIV-positive adults to able to attend their education is important.