What the study found
Retention in HIV care in Manaus is shaped by a mix of social and health system factors. Health care providers described poverty, stigma, transportation problems, and service constraints as major barriers to people living with HIV staying in care.
Why the authors say this matters
The authors conclude that retention in care is essential for viral suppression and for progress toward the UNAIDS 95-95-95 targets, which refer to diagnosing 95% of people with HIV, treating 95% of those diagnosed, and achieving viral suppression in 95% of those treated. They suggest that integrated, multisectoral strategies are needed to address socioeconomic vulnerabilities and service-level barriers.
What the researchers tested
The study used a qualitative cross-sectional design in six public health facilities in Manaus, Brazil, from November 2023 to October 2025. The researchers interviewed 56 health care providers, including physicians, nurses, social workers, psychologists, pharmacists, and HIV/AIDS program state managers, and analyzed the interviews with thematic framework analysis using MAXQDA software.
What worked and what didn't
Six themes emerged: monitoring and follow-up, loss to follow-up, the effect of loss to follow-up on UNAIDS goals, barriers to retention, strategies to improve retention, and state-level initiatives. Providers identified barriers such as poverty, food insecurity, unemployment, stigma, discrimination, transportation barriers, substance use, workforce shortages, long waiting times, and lack of privacy; proposed strategies included multidisciplinary teams, ongoing training, patient-centered and stigma-free care, active patient tracing, digital communication tools, decentralizing services, and better financial and human resources.
What to keep in mind
The findings come from provider perspectives in six public health facilities in Manaus, so they reflect that setting. The abstract does not describe patient interviews or measure the effectiveness of the proposed strategies.
Key points
- Health care providers in Manaus linked poor HIV-care retention to social and health system barriers.
- Reported barriers included poverty, food insecurity, unemployment, stigma, discrimination, transportation problems, substance use, and service constraints.
- The study was based on 56 semi-structured interviews with providers in six public health facilities.
- Proposed strategies included multidisciplinary teams, patient-centered care, active tracing, digital communication, and decentralized services.
- The authors say retention in care is important for viral suppression and UNAIDS 95-95-95 progress.
Disclosure
- Research title:
- Retention in HIV care is shaped by social and system barriers
- Authors:
- Zeca Manuel Salimo, Elizangela Farias da Silva, Michael Nosano Yakubu, Paulo Afonso Nogueira, Adele Schwartz Benzaken
- Institutions:
- AIDS Healthcare Foundation, Lúrio University, Fundação de Medicina Tropical, Instituto de Investigação Agrária de Moçambique, Universidade Federal do Amazonas, Universidade do Estado de Santa Catarina, Federal University Lafia, Fundação Oswaldo Cruz
- Publication date:
- 2026-04-14
- OpenAlex record:
- View
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