Barriers and Facilitators to HIV Treatment Adherence in Indonesia: Perspectives of People Living with HIV and HIV Service Providers

Abstract

HIV treatment adherence in Indonesia is a major challenge. Although previous studies have demonstrated several barriers and facilitators to adherence, studies providing a comprehensive analysis from both PLHIV and HIV service providers’ perspectives are limited, especially in Indonesia. In this qualitative study with 30 people living with HIV on treatment (PLHIV-OT) and 20 HIV service providers (HSPs), we explored, via online interviews, the barriers and facilitators to antiretroviral therapy (ART) adherence using a socioecological approach. Both PLHIV-OT and HSPs reported stigma as a major barrier at each socioecological level, including public stigma at the societal level, stigma in healthcare settings, and self-stigma at the intrapersonal level. Stigma reduction must therefore be prioritized. PLHIV-OT and HSPs also reported support from significant others and HSPs as the foremost facilitators to ART adherence. The enablement of support networks is thus an important key to improved ART adherence. Overall, the societal level and health system barriers to ART adherence should be addressed in order to remove barriers and enhance the facilitators at the subordinate socioecological levels.

HIV/AIDS in Indonesia: current treatment landscape, future therapeutic horizons, and herbal approaches

“…Support from significant others and healthcare providers was identified as a key facilitator for ARV adherence. Therefore, reducing stigma and enabling support networks are crucial for improving adherence to ARV in Indonesia ( 16 ). Another study emphasized the importance of self-awareness in maintaining adherence to ARV among PLHIV in Indonesia.…”

Does adherence to antiretroviral therapy differ by place of residence in Nigeria? A systematic review and meta-analysis protocol

“…It is recommended that people living with HIV (PLWH) should use at least 95% of prescribed antiretroviral medications to attain and maintain viral suppression 5. Adherence to ART can be challenging because PLWH need 95% treatment compliance to achieve viral suppression, which helps to achieve an undetectable viral load 6 7. PLWH with undetectable viral load often are not able to transmit HIV to other persons, which is known as treatment-as-prevention 7.…”

“…PLWH with undetectable viral load often are not able to transmit HIV to other persons, which is known as treatment-as-prevention 7. Not being able to transmit HIV due to viral suppression is the ultimate aim of the HIV treatment cascade, which has a positive ripple effect on stigma prevention, improved quality of life and prevention of AIDS-related death 6 8–10…”

“…Retention in care is still a significant challenge in the HIV treatment cascade and varies extensively across regions, leading to poor adherence to ART 11 12. Several factors across different socioecological levels, such as environmental and health-level factors, serve as barriers to ART adherence 5 6 13. In Nigeria and elsewhere, poor socioeconomic status, stigma, pill burden, poor support and distance to ART clinics have been identified as barriers to ART adherence 14–16…”

Emerging Diseases/Viruses Prevention, Control, Surveillance, and One Health

“…Two further articles attend to HIV; the first studies the barriers to and facilitators of adherence to antiretroviral therapy in Indonesia by employing a socioecological approach [ 16 ]. The second evaluates the impact of COVID-19 on receiving an HIV diagnosis in children, particularly regarding the prevention of the mother-to-child transmission of HIV in Johannesburg, South Africa [ 17 ].…”