Factors associated with antiretroviral therapy adherence among people living with HIV in Indonesia: A scoping review.

Abstract

Background: HIV remains a significant global health concern, especially in low-middle income countries. Indonesia ranked fourth in HIV cases in Asia in 2020, reporting 456,453 HIV cases by the end of 2021. The Indonesian government has taken various actions to combat HIV, including establishing the AIDS Commission to develop national policies and providing universal access to Antiretroviral Treatment (ART). Despite the impressive progress in lowering the AIDS case fatality rate among people living with HIV, medication adherence remains a significant challenge. The low ART adherence rates in Indonesia could lead to increased new HIV infections, potentially losing lives and income. Improvement in ART medication treatment and services is crucial to address this situation. The study aims to map out literature on the factors associated with adherence among people living with HIV in Indonesia.

Methods: Four electronic databases were searched for studies published from 2004. Additionally, to ensure comprehensive inclusion of relevant publications that might have been overlooked during the initial literature search, both a grey literature and a manual search of the reference lists of the included studies were conducted. Subsequently, the screening procedure involved evaluating the titles and abstracts first, followed by a full-text screening. Studies were chosen based on predefined inclusion and exclusion criteria.

Results: The initial search recognized 134 studies, of which 16 were included in the scoping review, with the majority being observational studies with cross-sectional methodology. The study identified seventeen factors and further divided into four main themes, including: patient factors, social-economic factors, medication factors, and health structure factors.

Conclusion: Among the four themes emerged, patient and social factors were the most discussed in the included studies. Five factors appear to be the most critical: self-efficacy, self- esteem, family and spouse support, stigma, and type of ARV. Understanding and addressing these factors could lead to targeted interventions to improve ART adherence and ultimately enhance the health outcomes of people living with HIV (PLHIV) in Indonesia. Recommendations for improving adherence include involving PLHIV's family in the HIV management, providing transportation assistance, and clinicians actively providing essential support for PLHIV.