Trends and disparities in retention to antiretroviral therapy of people living with HIV from 2014 to 2022 in Brazil: a population-based study

INTRODUCTION: Retention to antiretroviral therapy (ART) is critical for controlling HIV/AIDS and reducing mortality rates worldwide. In Brazil, although ART is widely accessible, challenges remain in retaining individuals on treatment over time. This study aims to analyze trends in ART retention from 2014 to 2022, addressing gaps in current national data. METHODS: This is a population-based, cross-sectional study, that utilized data from the Brazilian national ART monitoring system to assess retention rates at 6-, 12-, 24-, 36-, 48-, and 60-months post-ART initiation. The analysis included individuals aged 15-years or older, with retention defined as no more than a 28-day delay in drug distribution. Descriptive analyses of retention from 2014 to 2022 were conducted using R version 4.0 (R Core Team, 2020) and SPSS version 21 (IBM Corp.) RESULTS: The study observed over 3.4 million ART distributions, revealing that retention rates steadily declined over time, with the lowest rates observed at 60-months (71% in 2022). Men had consistently higher retention rates compared to women (79% vs. 73% in 2022). Lower retention was found among younger age groups (74% in 2022), indigenous populations (67% in 2022), individuals with lower education levels (72% in 2022), and those residing in northern (74% in 2022) regions of Brazil. CONCLUSIONS: The study highlights considerable retention challenges, particularly after extended periods on ART, with notable disparities across demographic and regional groups. The findings suggest the need of interventions to improve ART retention, especially among vulnerable populations, to reach the 95-95-95 targets in Brazil. The introduction of multi-month drug dispensing and other strategies implemented during the COVID-19 pandemic may have helped stabilize retention rates in recent years.