Letter of the Day | Closing the gap in the HIV treatment cascade

THE EDITOR, Madam:

Jamaica continues to face persistent gaps in the HIV treatment cascade, from diagnosis to viral suppression. In Kingston and St Andrew (KSA), where patient volumes are highest and care is often fragmented across multiple service points, these gaps are especially evident. Many individuals remain unlinked to care, inadequately retained, or unable to achieve viral suppression, while others remain undiagnosed. The treatment cascade examines the progression from those estimated to be living with HIV (including the undiagnosed) to those who ultimately achieve viral suppression and are unable to transmit the virus. 

Several years ago, the then HIV/STI coordinator for KSA was tasked with leading a pilot initiative to merge curative and HIV/STI services within a primary care setting. Formulation of a plan for this integration was commenced. Although ambitious, the effort faced challenges, including limited infrastructure, constrained human resources, and the onset of the COVID-19 pandemic. Some of these barriers persist, but the need for integration remains urgent. 

In urban centres, patients frequently navigate multiple clinics for different services, increasing wait times, transportation costs, and the risk of disengagement from care. A more coordinated, patient-centred approach is required. Integrating curative and HIV/STI services within primary care offers a practical solution. By reducing fragmentation and normalising HIV care within general health services, this model can improve access, strengthen retention, and enhance outcomes. 

A pilot programme in a high-volume primary care facility in KSA could feasibly demonstrate this approach and provide evidence for scalability, nationally. Designated, shared clinical spaces, unified patient registration, and integrated triage systems would allow patients to move through care seamlessly, with minimal visible distinctions that may contribute to stigma. 

This approach aligns with the priorities of the Ministry of Health and Wellness in Jamaica, including strengthening primary healthcare, advancing patient-centred service delivery, and achieving national HIV targets. Global evidence also supports integration at the primary care level. A 2021 meta-analysis on integrated HIV services found improvements in treatment uptake, retention, and overall health system performance. Closing the gaps in the treatment cascade will require decisive, coordinated action. Integration is not optional – it is essential to achieving equitable healthcare and ending AIDS as a public health threat by 2030.    

DR STACEY-ANN BROWN

[email protected]