Published in PLOS One on 2026-09-15, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Desalegn Dawit Assele, Yitayew Ewnetu Mohammed, Abera Gezume Ganta, Tadele Dana Darebo, Sileshi Demelash Sasie
Source: PLOS One • DOI 10.1371/journal.pone.0358352
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
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.
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%).
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.
Introduction
Human Immunodeficiency Virus (HIV) remains a major global public health challenge, particularly in resource-limited countries, with substantial morbidity, mortality, and socioeconomic impact. As of 2024, an estimated 40.8 million people were living with HIV worldwide, with a disproportionately high burden in sub-Saharan Africa, accounting for nearly two-thirds of all people living with HIV (PLHIV) and the majority of acquired immunodeficiency syndrome (AIDS) – related deaths. As of 2024, national estimates from Ethiopia indicate that over 570,000 adults are living with HIV, with a prevalence rate of approximately 0.7% and an estimated 8,400 AIDS-related deaths annually [1–4].
Advances in antiretroviral therapy (ART) over the past two decades have transformed HIV/AIDS from an almost universally fatal disease into a chronic, manageable condition, significantly improving the life expectancy of PLHIV. Moreover, the significantly reduced risk of HIV transmission due to viral suppression with the use of ART has been central to efforts to stop the HIV epidemic [5,6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Desalegn Dawit Assele, Yitayew Ewnetu Mohammed, Abera Gezume Ganta, Tadele Dana Darebo, Sileshi Demelash Sasie. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Virologic suppression among HIV-positive pregnant and lactating women receiving antiretroviral therapy in Africa: A systematic review and meta-analysis
- Evidence brief: Evaluating the effects of community-based programs on viral rebound and viral suppression among HIV-positive orphaned and vulnerable children receiving antiretroviral treatment: Findings from the ACHIEVE project in Tanzania
- Evidence brief: Factors associated with high viral load among HIV clients aged 15 years and older receiving treatment in Tanga city council, Tanzania: A facility-based cross-sectional study
