Abstract
Background: People living with HIV lack access to sufficient quantities of nutritious foods and develop the feeling of hunger as a result of food insecurity. Studies suggest that there is gender-based inequality in the experience of food insecurity. The few studies conducted on the prevalence of food insecurity among adults living with HIV in Ethiopia presented inconclusive finding. Therefore, the objective of the current systematic review and meta-analysis was to estimate the pooled prevalence of food insecurity and its gender disparity among adult patients living with HIV receiving antiretroviral therapy in Ethiopia.

Method: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were accessed through electronic web-based search from PubMed, Google Scholar, CINAHL, PopLine, MedNar, Embase, Cochrane library, the JBI Library and the web of science. We included studies conducted on the prevalence of food insecurity adults living with HIV receiving antiretroviral therapy whose age was greater than 18 years. The meta-analysis was conducted using STATA 14 software. A random effects model was used to estimate the pooled prevalence at 95% CI. Funnel plots and Egger’s and Begg’s tests were used to check for publication bias.

Results: A total of 52 studies were identified of which eleven studies included in the meta-analysis with a total of 4031 adult people living with HIV receiving antiretroviral therapy. The overall pooled estimated prevalence of food insecurity among adult people living with HIV receiving antiretroviral therapy in Ethiopia was 63.44 % (95% CI (46.33% - 80.54%)). The analysis indicated that there was gender disparity in pooled prevalence of food insecurity. The findings showed a higher pooled prevalence of food insecurity among female (68.85%, 95% CI (57.88%, 79.81%)) compared to males (31.15%, 95% CI (20.19%, 42.12%)).

Conclusion: The review demonstrates the high overall pooled prevalence of food insecurity among adult people living with HIV receiving antiretroviral therapy in Ethiopia with high gender disparities. Therefore, the interventions should be culture and context specific to address the regional and gender disparities in the prevalence of food insecurity.

Keywords: food insecurity, adult people, gender disparity, HIV, Ethiopia