Targeted Interventions Needed to Help HIV Patients Connected to Care

Health researcher Selena Lewis has highlighted the need for targeted interventions to keep HIV patients connected to life-saving treatment.

The recommendation is in light of her study, which shows that individuals, aged 20 to 49 years, particularly men, are at greater risk of dropping out of care.

The findings were presented at the recent 16 th Annual National Research Conference held at The Jamaica Pegasus hotel in New Kingston, which looked at the factors influencing whether People Living with HIV (PLHIV) remain engaged in treatment and care services.

The research focused on PLHIV accessing care at public treatment sites across Jamaica and sought to identify the characteristics associated with retention versus loss of follow-up.

Miss Lewis, who is the Monitoring and Evaluation Officer (HIV Treatment) in the Ministry of Health and Wellness, said that retention in care is one of the most pressing challenges facing the country's HIV response, despite significant gains in diagnosis and treatment.

She explains that retention in care refers to whether PLHIV remain actively engaged in treatment and clinical follow-up over time. Patients are considered retained in care if they have not missed appointments for more than 90 days, while those absent for longer periods are categorised as lost to follow-up.

Maintaining consistent care is essential because it allows patients to remain on antiretroviral therapy (ART), achieve viral suppression, and reduce the risk of transmitting the virus to others.

Providing an overview of Jamaica’s HIV response, Miss Lewis noted that the country has made considerable progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets.

As of July 2025, Jamaica had an estimated 28,000 people living with HIV, of whom approximately 26,500, or 95 per cent, had been diagnosed.

However, only 14,930 individuals, representing 56 per cent of those diagnosed, were retained in care.

Among those receiving treatment, 81 per cent had achieved viral suppression.

Miss Lewis said that the biggest gap is between people living with HIV diagnosed and those retained on antiretroviral therapy. “That is what we are trying to address through this study,” she noted.

The research team analysed data from Jamaica’s centralised web-based HIV treatment information system, which links treatment sites across the island.

The study examined a sample of 12,542 persons living with HIV. Of these, 10,466 individuals or 83 per cent, were retained in care, while 2,076, representing 17 per cent, had been lost to follow-up.

The researchers identified several demographic and clinical factors associated with retention, including age, gender, marital status, treatment location, viral suppression status, CD4 count, and the presence of multiple health conditions.

Factors such as employment status, disclosure of HIV status, financial assistance, key population status, and the number of days between diagnosis and ART initiation did not show a significant association with retention in the Jamaican data set.

One of the most striking findings involved age, with Mr. Lewis reporting that persons between 20 and 49 years old were significantly less likely to remain in care than individuals aged 50 years and older.

The greatest vulnerability was observed among those aged 25 to 39 years, a group often balancing employment, family responsibilities, and other competing demands.

Married individuals were twice as likely to remain in care compared to those who were single, suggesting that social and emotional support may play an important role in treatment adherence.

Gender differences also emerged. Females were more likely to remain engaged in care than males, reinforcing concerns about the challenges men face in accessing and maintaining healthcare services.

Persons, who attended treatment facilities outside their parish of residence were less likely to remain in care than those who sought treatment within their own parish, highlighting transportation challenges, scheduling difficulties, and the possible influence of stigma and confidentiality concerns.

Among all the factors examined, the impact of technology stood out most dramatically.

Miss Lewis reveals that individuals receiving SMS appointment reminders were 20 times more likely to be retained in care than those who did not receive reminders. This is a simple but highly effective intervention that could significantly improve retention rates if implemented more widely across treatment sites.

The study also found that patients with suppressed or undetectable viral loads were more likely to remain engaged in care than those whose virus was not controlled.

Interestingly, persons with lower initial CD4 counts, indicating more advanced disease, were more likely to stay connected to treatment than those who entered care with higher CD4 counts.

Miss Lewis suggested that patients who feel healthier at diagnosis may underestimate the importance of continuous care, leading to disengagement over time.

The analysis further revealed regional differences. Treatment sites located in Hanover, Manchester, Portland, St. Elizabeth, St. James, St. Mary, St. Thomas, and Trelawny demonstrated higher retention rates than sites in Kingston.

While the study did not fully explain these variations, the findings suggest that local service delivery models and community factors may influence patient engagement.

The research team highlighted the need for expanded treatment, literacy programmes, greater use of SMS reminders, integrated services for patients with multiple health conditions, and improved clinic accessibility through extended and weekend hours.

Responding to questions following her presentation, Miss Lewis emphasised that stigma remains a persistent barrier, highlighted the need for stronger efforts to address discrimination.

She noted that the Ministry and other organisations continue to educate the public about HIV transmission and challenge misconceptions that fuel discrimination.

“It starts from the individual learning that HIV is not transmitted by mosquito bites or by sharing food with somebody else,” she said.

“By doing these little things, we hope that stigma and discrimination will be reduced in Jamaica,” she added.

Ultimately, Miss Lewis said that strengthening retention in care is essential if Jamaica is to achieve its HIV goals.

While diagnosis rates are encouraging, keeping people connected to treatment remains the key to improving health outcomes, reducing transmission, and moving closer to ending the HIV epidemic as a public health threat.

By Garfield L. Angus