Prevalence and determinants of virologic failure among HIV patients on ART in Africa: A systematic review and meta-analysis

BACKGROUND: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has established the 95-95-95 targets, aiming that by 2030, 95% of individuals on ART will achieve viral suppression. While the number of people receiving ART has increased significantly, there is a lack of comprehensive data on the pooled prevalence of virological failure among people living with HIV in Africa. Therefore, this systematic review and meta-analysis aims to assess the prevalence of virological failure and identify contributing factors within this population. METHODS: An extensive search was carried out using databases such as African Journals Online, PubMed, the Cochrane Library, and Google Scholar to find relevant studies examining virological failure and its influencing factors. To assess variability between studies, the IAý statistic was utilized, while Egger’s test was employed to detect any signs of publication bias. The overall prevalence of virological failure was estimated using the DerSimonian-Laird random-effects model. Additionally, sensitivity analysis was conducted to determine the robustness of the findings and to identify any studies with results that significantly deviated from the rest. RESULT: Out of nine articles, the overall pooled prevalence of virological failure was 11.54% (95% CI: 5.950-17.128, IAý=30.7%). In the African country, virological failure was associated with ART interruption (PORƒ_%=ƒ_%7.09 (95% CI: 2.09, 24.09; IAý = 79.5%, Pƒ_%=ƒ_%0.027)), poor adherence (PORƒ_%=ƒ_%9.0 (95% CI: 5.41, 14.96; IAý = 0.0%; Pƒ_%=ƒ_%0.709)), TB/HIV co-infection (PORƒ_%=ƒ_%6.17 (95% CI: 1.17-32.42; IAý = 89.9%; Pƒ_%=ƒ_%0.002)), and CD4 count/percentage (PORƒ_%=ƒ_%7.70 (1.77, 33.42); IAý = 84.4%, Pƒ_%=ƒ_%0.011)). CONCLUSION AND RECOMMENDATION: Virological failure was found to be relatively high in Africa. Therefore, to accelerate progress toward these goals, policymakers should design and implement mechanisms aimed at improving adherence to antiretroviral therapy (ART), preventing treatment interruptions, and reducing the incidence of opportunistic infections such as TB. Furthermore, we recommend that researchers conduct exploratory studies to identify additional factors associated with virological failure, which could inform more targeted and effective interventions

• Epidemiology and Determinants of Health
  • Epidemiology
• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Treatment
• Co-infections
  • Tuberculosis
• Health Systems
  • Governance arrangements
  • Delivery arrangements