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Retention in HIV care in Manaus is shaped by social and system barriers

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Research area:medicine-clinical

What the study found

Health care providers said that retention in HIV care in Manaus is influenced by both social pressures and service-related problems. They identified poverty, food insecurity, unemployment, stigma, discrimination, transportation barriers, substance use, and health system constraints as major drivers of loss to follow-up.

Why the authors say this matters

The authors conclude that integrated, multisectoral strategies are needed to address socioeconomic vulnerabilities and service-level barriers. The study suggests this is important for improving long-term engagement in care and advancing progress toward the UNAIDS 95-95-95 targets.

What the researchers tested

The researchers conducted a qualitative cross-sectional study in six public health facilities in Manaus, Brazil, from November 2023 to October 2025. They carried out semi-structured, in-depth interviews with 56 health care providers, including physicians, nurses, social workers, psychologists, pharmacists, and HIV/AIDS program state managers, and analyzed the data using thematic framework analysis with MAXQDA software.

What worked and what didn't

Six themes emerged: monitoring and follow-up of people living with HIV, challenges related to loss to follow-up, impact on UNAIDS 95-95-95 goals, barriers to retention, strategies to optimize retention, and state-level initiatives. Providers proposed strengthening multidisciplinary teams, ongoing professional training, patient-centered and stigma-free care, active patient tracing, digital communication tools, decentralizing services, and adequate financial and human resources.

What to keep in mind

This summary reflects provider perspectives from six public health facilities in Manaus, so it does not directly measure patient outcomes. The abstract does not describe specific limitations beyond the study setting and qualitative design.

Key points

  • 56 health care providers were interviewed across six public health facilities in Manaus.
  • Providers identified poverty, food insecurity, stigma, transportation barriers, and substance use as drivers of disengagement.
  • Health system constraints included workforce shortages, long waiting times, and lack of privacy.
  • The authors say integrated, multisectoral strategies are needed to improve retention in care.
  • Proposed strategies included multidisciplinary teams, active tracing, digital communication, and decentralizing services.

Disclosure

Research title:
Retention in HIV care in Manaus 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, AIDS Healthcare Foundation, Federal University Lafia, Fundação de Medicina Tropical, Fundação de Medicina Tropical, Fundação de Medicina Tropical, Fundação Oswaldo Cruz, Instituto de Investigação Agrária de Moçambique, Lúrio University, Universidade do Estado de Santa Catarina, Universidade Federal do Amazonas, Universidade Federal do Amazonas, Universidade Federal do Amazonas, Universidade Federal do Amazonas
Publication date:
2026-04-14
DOI:
10.1186/s12981-026-00885-2
OpenAlex record:
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AI provenance: This post was generated by gpt-5.4-mini (OpenAI). The original authors did not write or review this post.

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