Antiretroviral Therapy Engagement and Retention in Resource-Limited Settings

Effective engagement and sustained retention in antiretroviral therapy (ART) programmes are pivotal to achieving durable viral suppression and reducing HIV-related morbidity in low- and middle-income countries. In resource-limited settings, individuals commence lifelong treatment amid constrained infrastructure, variable service quality and socioeconomic pressures. Retention encompasses not only clinic attendance but seamless continuation of medication, regular monitoring of immunological and virological status and prompt re-engagement after interruptions. Barriers to sustained engagement include drug side effects, stigma, mental-health challenges, transport costs and unexpected life events such as migration. Health-system factors such as rigid appointment schedules, stock-outs of medicines and insufficiently trained staff further compound attrition. Recent efforts have shifted towards person-centred models of care, community-based delivery, differentiated service delivery and robust data systems to track patients across facilities. Interventions that combine flexible delivery of ART, counselling and peer support with timely tracing of those lost to follow-up have demonstrated improvements in long-term retention. Coordinated strategies at individual, community and facility levels remain essential to close gaps in the HIV care continuum and to meet global targets for epidemic control.

Research from Nature Portfolio

A person-centred re-engagement initiative evaluated in a peri-urban South African township introduced a “Welcome Service” at the point of return after treatment interruption. The intervention reorganised triage procedures, optimised counselling and clinical workflows and emphasised respectful staff–patient interactions. Programme data showed same-day ART re-initiation in almost all participants, with two-thirds retained at four months and nearly nine in ten achieving low viral loads. Qualitative feedback underscored that, despite persistent judgements by some health-care workers, patients valued the tailored attention and rapid linkage back to care. This study illustrates how modest reorganisation of existing resources, underpinned by psychosocial support principles, can bolster retention and viral suppression after disengagement.

Antiretroviral Therapy Engagement and Retention in Resource-Limited Settings publication trend

The graph below shows the total number of articles in antiretroviral therapy engagement and retention in resource-limited settings across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral therapy (ART): Lifelong combination of drugs that suppress HIV replication and preserve immune function.

Retention: Continuation in care and on ART without interruption, including regular clinic visits and medication refills.

Viral load: Measurement of HIV RNA copies per millilitre of blood, used to assess treatment effectiveness.

Loss to follow-up (LTFU): Classification of a patient who has missed scheduled visits beyond a defined interval and whose status is unknown.

Re-engagement: Process of returning patients who have interrupted care back into continuous treatment and monitoring.

References

1. Reasons for disengagement from antiretroviral care in the era of “Treat All” in low‐ or middle‐income countries: a systematic review. Journal of the International AIDS Society (2024).
2. Supporting re-engagement with HIV services after treatment interruption in South Africa: a mixed method program evaluation of MSF’s Welcome Service. Scientific Reports (2024).
3. Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis. Clinical Infectious Diseases (2018).