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BackgroundOptimal medication adherence is vital for the successful implementation of highly active antiretroviral therapy (HAART) in managing HIV infection. Global efforts aim to minimize the burden of antimicrobial resistance (AMR), including HIV-associated drug resistance.MethodsThis systematic review and meta-analysis followed PRISMA guidelines and searched multiple databases for eligible studies published until July 10, 2023. Eligible studies focused on Ethiopians receiving HAART, reported the prevalence of optimal adherence, and used appropriate assessment tools. Quality of included studies was assessed using JBI checklists A weighted inverse variance random-effects model was applied to calculate the pooled prevalence.ResultsOur meta-analysis aimed to determine the pooled prevalence of optimum Highly Active Antiretroviral Therapy (HAART) adherence among HIV-positive adults in Ethiopia and explore variations based on assessment methods, recall periods, and regional factors. The estimated national pooled prevalence of optimal HAART adherence was 79% (95% CI: 74–83, I2 = 98.1%; p-value < 0.001). Assessment methods revealed a prevalence of 64% (95% CI: 54–73) using structured assessment and 82% (95% CI: 78–86) with self-reporting. Optimum adherence varied based on recall periods, ranging from 78 to 85% with self-reporting. Heterogeneity analysis indicated substantial variation (I2 = 98.1%; p-value < 0.001), addressed through subgroup analysis, sensitivity analysis, and univariate meta-regression. Subgroup analysis based on region identified varying prevalence: SNNPR (83%), Oromia (81%), Amhara (79%), and Addis Ababa (74%). Considering the 2018 guideline revision, year-based subgroup analysis showed a prevalence of 78% and 78% before and after 2018, respectively. Sensitivity analysis demonstrated the stability of results, with excluded studies having a minimal impact. Publication bias analysis indicated an absence of bias, as evidenced by a non-significant Egger's regression test (p-value = 0.002) and no adjustment in trim and fill analysis.ConclusionsThe estimated overall prevalence of optimal adherence was 79%, indicating a substantial level of adherence to HAART in the Ethiopian context. The study identified variations in adherence levels based on assessment methods and recall periods, highlighting the importance of considering these factors in evaluating adherence rates. These insights contribute valuable information for policymakers, healthcare practitioners, and researchers working toward enhancing HAART adherence in Ethiopia.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459679

BackgroundUncontrolled hypertension (HTN) is a major risk factor for cardiovascular and cerebrovascular disease. The prevalence of HTN in the Ethiopian adult population is almost 20%.This study aimed to determine the prevalence of uncontrolled HTN and its contributing factors among patients with HTN in Ethiopia undergoing treatment.MethodsElectronic bibliographic databases such as PubMed, Google Scholar, Hinari (Research4Life), Embase, and Scopus were searched for original records in the English language that assessed HTN control in Ethiopia and were available before 29 June 2023. The data were extracted using a format prepared in Microsoft Excel and exported to the software STATA 17.0 for analysis. The study protocol was registered at PROSPERO with the reference number CRD42023440121.ResultsA total of 26 studies with 9,046 patients with HTN were included in the systematic review and meta-analysis, of which 11 studies were used to assess factors contributing to uncontrolled blood pressure (BP) in patients in Ethiopia. The estimated prevalence of uncontrolled HTN in the population of Ethiopia is 51% [95% confidence interval (CI), 42%–60%]. The subgroup analysis, based on the assessment tools, region, and follow-up period, revealed that the prevalence of uncontrolled BP was highest following the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) (89%; 95% CI: 87%–91%) and in Addis Ababa (58%; 95% CI: 40%–76%), and the lowest proportion of uncontrolled BP was in the 3-month follow-up period (34%; 95% CI: 29%–39%). The presence of diabetes mellitus showed the highest impact (pooled odds ratio: 5.19; CI: 1.41–19.11) for uncontrolled HTN. The univariate meta-regression method confirmed that the sample size, year of publication, and subgroups were not sources of heterogeneity in the pooled estimates. Egger's regression test did not indicate the presence of publication bias.ConclusionMore than half of the hypertensive patients in Ethiopia have uncontrolled BP. Diabetes mellitus, advanced age, male sex, and the presence of comorbidities are among the factors contributing to uncontrolled HTN in Ethiopia. The concerned bodies working in this area should implement interventional strategies and recommendations that might be helpful in achieving optimal BP in hypertensive patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440121, PROSPERO (CRD42023440121).