Incidence and predictors of attrition among children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: To estimate the pooled attrition rate among HIV-infected children receiving antiretroviral therapy (ART) and identify predictors of attrition in Ethiopia. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, HINARI, Web of Science, African Journals Online and Google Scholar were searched up to 20 February 2025. ELIGIBILITY CRITERIA: Cohort studies conducted in Ethiopia that reported attrition from ART and its predictors among children, published as full-length articles in English, were included. DATA EXTRACTION AND SYNTHESIS: Three independent reviewers extracted data and assessed study quality using the Joanna Briggs Institute checklist for cohort studies. Heterogeneity was assessed using the I² statistic. Publication bias was evaluated with funnel plots and Egger's test. A random-effects model was applied to estimate the pooled attrition rate. RESULTS: Among 1093 studies identified, 14 met the inclusion criteria and were included in the analysis. The pooled attrition rate among HIV-infected children receiving ART was 6.04 per 100 person-years of observation (95% CI 4.90 to 7.44). Anaemia (HR=3.39; 95% CI 2.40 to 4.78), suboptimal ART adherence (HR=2.33; 95% CI 1.39 to 3.89) and underweight status (HR=3.43; 95% CI 2.04 to 5.78) were significantly associated with higher attrition. CONCLUSIONS: The pooled attrition rate among HIV-infected children receiving ART in Ethiopia is relatively low. Nevertheless, enhanced counselling on ART adherence is crucial to further reduce attrition, and special attention should be given to children with anaemia or underweight status. PROSPERO REGISTRATION NUMBER: CRD420251015059.