Global Level of Adherence to Antiretroviral Treatment for Human Immunodeficiency Virus Infection in the World Health Organization’s Test and Treat Era in West Africa: A Systematic Review and Meta-Analysis

Background: In West Africa, where the WHO “test and treat” policy has been implemented since 2016, evidence on adherence levels remains limited. Objectives: To systematically assess adherence to ART among people living with HIV. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. We searched PubMed, Scopus, Web of Science, and Google Scholar for studies published between January 2016 and December 2023. Eligible studies reported adherence rates to ART among populations in West Africa after implementation of the test and treat strategy. We did not specify standardized measurement tools for measuring adherence. All measurement methods were taken into account. Study selection and data extraction were performed in duplicate. Pooled adherence proportions were estimated using a random-effects model. Publication bias was assessed with funnel plots and Egger’s test. Results: Of 385 records screened, seven studies from Nigeria (3), Ghana (2), Sierra Leone (1), and Burkina Faso (1) were included, comprising 4436 participants. Adherence definitions varied (self-report, caregiver report, medical records). The pooled adherence rate was 63% (95% CI 45% - 79%). Adults’ adherence was 78%, 95% CI 66% - 88% compared with children, 23%, 95% CI 0% - 71%. Funnel plot inspection and Egger’s test suggested possible publication bias. Conclusions: Adherence to ART in West Africa remains below optimal levels. Context-adapted interventions are urgently needed.