Burden and Associated Factors of Virological Failure Among People Living with HIV in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

AIDS Behav. 2022 Oct;26(10):3327-3336. doi: 10.1007/s10461-022-03610-y. Epub 2022 Apr 13.


United Nations program on HIV/AIDS 90-90-90 ambitious goal recommends 90% of people living with HIV and taking antiretroviral therapy should achieve viral suppression by 2020. However, virological failure is still a global public health problem, especially in sub-Saharan African countries. Thus, this systematic review and meta-analysis aimed at estimating the burden of virological failure and its associated factors among peoples living with HIV in sub-Saharan Africa. We searched Google Scholar, PubMed, Cochrane Library, and Scopus for studies that reported virologic failure and its associated factors. I-squared statistics and Egger's statistical test were used to detect heterogeneity and publication bias respectively. The pooled prevalence of virological failure was estimated using the DerSimonian-Laird random-effects model. Sensitivity analysis was done to check the presence of outlier results included in the studies. The estimated pooled prevalence of virological failure was 1.7.25%. Lower Adherence to ART drugs,longer ART duration, lower CD4 count,and being co-infected with TB were significantly associated with the pooled estimate of virological failure.Virological failure was found to be high in sub-Saharan Africa. Adherence, duration of ART, CD4 + count, and TB co-infection were the significant factors associated with the pooled estimate of virological failure. Therefore, to achieve the 90-90-90 target and sustainable development goal 3 policymakers should design mechanisms to improve ART adherence, and early detecting and prevent opportunistic infections such as TB.

Keywords: Africa; HIV; Sub-Saharan; Virological failure.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Acquired Immunodeficiency Syndrome*
  • Africa South of the Sahara / epidemiology
  • CD4 Lymphocyte Count
  • Coinfection*
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • Humans