Barriers to access to antiretroviral therapy by people living with HIV in Indonesia during the COVID-19 pandemic: A qualitative study

Abstract

Background: The coronavirus disease (COVID-19) pandemic has a significant influence on access to healthcare services. This study aimed to understand the views and experiences of people living with HIV (PLHIV) about barriers to their access to antiretroviral therapy (ART) service in Belu district, Indonesia, during the COVID-19 pandemic. Methods: This qualitative inquiry employed in-depth interviews to collect data from 21 participants who were recruited using a snowball sampling technique. Data analysis was guided by a thematic framework analysis. Results: The findings showed that fear of contracting COVID-19 was a barrier that impeded access to ART service by the participants. Such fear was influenced by their awareness of their vulnerability to the infection, the possibility of unavoidable physical contact in public transport during a travelling to HIV clinic and the widespread COVID-19 infection in healthcare facilities. Lockdowns, COVID-19 restrictions and lack of information about the provision of ART service during the pandemic were also barriers that impeded their access to the service. Other barriers included the mandatory regulation for travellers to provide their COVID-19 vaccine certificate, financial difficulty, long-distance travel to the HIV clinic and a lack of public transport. Conclusions: The findings indicate the need for dissemination of information about the provision of ART service during the pandemic and the benefits of COVID-19 vaccination for the health of PLHIV. The findings also indicate the need for new strategies to bring ART service closer to PLHIV during the pandemic such as a community-based delivery system. Future large-scale studies exploring views and experiences of PLHIV about barriers to their access to ART service during the COVID-19 pandemic and new intervention strategies are recommended.

Understanding the quality of life of people living with HIV in rural and urban areas in Indonesia

“…These poor environmental conditions or limitations can be categorised as system-level barriers to access to HIV care services, as highlighted in previous findings in other settings [47,49]. Given that HIV cases in the district have been reported for nearly 20 years [50], such poor environmental conditions, especially the limited availability and delivery of HIV care service in the district, could be an indication of a lack of priority or focus by the local government to address HIV issue through policies and practices and allocate more resources to support HIV programs or interventions. These conditions seem to be worsened by the participant's poor financial situations, reflected in difficulties in fulfilling their needs, including access to healthcare, which is an important influencing factor for poor QoL as reported in previous studies in other settings [15,20,21].…”

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“…The findings indicate the immense burden HIV presents in these women's lives, which goes beyond medical challenges, and acknowledge the importance of comprehensive HIV interventions that address the mental health needs of these women. Such interventions are critical, especially for WLHIV in rural communities in Belu district where health care and mental health support for PLHIV are lacking or are very limited [14,35,36].…”