Barriers and Facilitators to Engagement in Antiretroviral Therapy in Low- and Middle-Income Countries

Antiretroviral therapy (ART) remains one of the most effective public health interventions for reducing HIV-related morbidity and mortality, preventing onward transmission, and improving the quality of life of people living with HIV (PLHIV). Global progress has been substantial: UNAIDS estimates that 40.8 million people were living with HIV in 2024, and 31.6 million were accessing ART. In the same year, the global treatment cascade reached 87–89–94, meaning that 87% of PLHIV knew their HIV status, 89% of those who knew their status were on treatment, and 94% of those on treatment were virally suppressed. Yet, when assessed across all PLHIV, only 77% were receiving treatment and 73% were virally suppressed, showing that the 95–95–95 targets remain unmet globally. UNAIDS also reports that at least seven countries achieved the 95–95–95 targets in 2024, while funding gaps and recent financial disruptions continue to threaten HIV service delivery in low- and middle-income countries (LMICs).In many resource-limited settings, access to ART is still shaped by persistent structural, health system, social, economic, legal, and behavioral barriers. These include weak health infrastructure, workforce shortages, stigma and discrimination, gender inequality, travel and transport costs, stock-outs, fragmented services, and challenges in long-term retention and adherence. At the same time, important facilitators such as differentiated service delivery, community-based models, peer support, digital adherence tools, integrated HIV services, and enabling policies are helping improve engagement with treatment in diverse LMIC contexts.The goal of this Research Topic is to advance understanding of how PLHIV in LMICs initiate, access, continue, and benefit from ART across the care continuum. Its objective is to generate robust and policy-relevant evidence on the barriers and facilitators to ART engagement that can inform context-sensitive policies, programs, and clinical and public health practice in LMICs.Submissions are welcome on, but not limited to:• Policies and practices related to ART in developing countries• Barriers and facilitators to PLHIV’s engagement with ART• Evaluations of programs or interventions related to ART or HIV treatment• Reviews of ART access, provision, and adherence• Linkage to HIV diagnosis and ART initiation• Retention in care and long-term treatment continuity• ART adherence and viral suppression outcomes• Community-led, peer-led, and differentiated service delivery models• Health system, financing, and workforce factors affecting ART delivery• Stigma, discrimination, gender, and legal or policy barriers to ART• ART access among key populations, adolescents, pregnant women, and other underserved groups• Digital health, telehealth, and mHealth approaches to support ART engagement• Implementation science studies on scaling up effective ART models• Equity-focused and mixed-methods research on ART access and treatment experiences Topic editors: Nelsensius Klau Fauk, Christina Yeni Kustanti, Pande Putu Januraga, Hailay Abrha Gesesew Source: https://www.frontiersin.org/research-topics/80735/barriers-and-facilitators-to-engagement-in-antiretroviral-therapy-in-low--and-middle-income-countries