ABSTRACT Background The pooled burden of HIV treatment failure and its associated factors in Ethiopian context is required to provide evidence towards renewed ambitious future goal. Methods Ethiopian Universities’ (University of Gondar and Addis Ababa University) online repository library, Google scholar, PubMed, Web of Science, and Scopus were used to get the research articles. I-squared statistics was used to see heterogeneity. Publication bias was checked by Egger’s regression test. The DerSimonian-Laird random effects model was employed to estimate the overall prevalence. Subgroup analysis based on geographical location of the study, study population by age, treatment failure type, and study design was conducted to see variation in outcomes. The sensitivity analysis was also employed to see whether the outlier result found in the included studies. Results Overall HIV treatment failure found to be 15.9% (95% CI: 11.6%-20.1%). Using immunological definition, HIV treatment failure was 10.2% (6.9%-13.6%); using virological definition of treatment failure (5.6% (95% CI: 2.9%-8.3%) and clinical definition of treatment failure (6.3% (4.6%-8.0%)) were also determined. The pooled effects of WHO clinical stage III/IV (AOR=1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (AOR=1.8; 95% CI: 1.2-2.4), and poor HAART adherence (AOR= 8.1; 95% CI: 4.3-11.8) on HIV treatment failure are estimated. Conclusions HIV treatment failure in Ethiopia found to be high. HIV intervention programs need to address the specified contributing factors of HIV treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain HIV treatment adherence. Protocol Registration It has been registered in the PROSPERO database (CRD42018100254).

Still poor HAART adherence has great impact on HIV/AIDS treatment failure in Ethiopia