Strategies to improve retention in care among people living with HIV at health facilities in Manaus, Brazil: insight from health care providers

Key findings from this study

This research indicates that:

• Socioeconomic vulnerabilities and service-level barriers jointly shape retention in HIV care within Manaus health facilities.
• Healthcare providers identify poverty, housing instability, and transportation access as primary patient-level obstacles to sustained care engagement.
• Integrated, multisectoral strategies addressing both socioeconomic determinants and facility-level factors are necessary to improve retention and progress toward 95-95-95 targets.

Overview

Retention in HIV care at health facilities in Manaus, Brazil remains suboptimal due to interacting social and systemic barriers. Healthcare provider perspectives illuminate how socioeconomic vulnerabilities and service-level deficiencies compromise long-term engagement in treatment and prevention programs.

Methods and approach

The study collected qualitative insights from healthcare providers at health facilities in Manaus regarding barriers and enablers of care retention. Provider perspectives directly informed identification of specific socioeconomic and institutional obstacles affecting patients' sustained participation in HIV care.

Results

Healthcare providers identified complex, overlapping factors that impede retention in HIV care. Socioeconomic vulnerabilities—including poverty, housing instability, and limited transportation access—interact with service-level barriers such as appointment scheduling inflexibility, insufficient psychosocial support, and inconsistent medication supply. Providers emphasized that individual-level interventions alone cannot sustain engagement in care without addressing these structural determinants.

The research underscores that effective retention requires integrated approaches spanning multiple sectors. Healthcare facilities must coordinate with social services, economic support programs, and community organizations to address patient-level obstacles while simultaneously strengthening service delivery capacity and responsiveness to patient needs.

Implications

Health facility leadership and policy makers should prioritize multisectoral collaboration to reduce retention barriers. Integration of socioeconomic support services with clinical care—rather than sequestering them as supplementary activities—addresses root causes of disengagement. Service redesign should incorporate provider input and patient-centered scheduling, medication access, and psychosocial support.

Progress toward UNAIDS 95-95-95 targets depends critically on retention improvements in resource-limited urban settings. Manaus and comparable contexts require sustained investment in structural interventions alongside clinical services. Provider perspectives serve as a foundation for identifying priority interventions; implementation research should test integrated strategies and measure their impact on sustained treatment engagement.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.