Why Counseling Intervention Fails to Improve Compliance towards Antiretroviral Therapy: Findings from a Mixed-Methods Study among People Living with HIV in Bali Province, Indonesia

Abstract

This study explores the contribution of counseling to improving acceptance of and adherence to anti-retroviral therapy (ART) among people living with HIV (PLHIV) and identifies key issues associated with its implementation. We conducted a longitudinal mixed-methods study in Bali Province between 2015 and 2017. The study participants were 170 newly diagnosed PLHIV and 17 outreach-counselor workers (OWs). We interviewed PLHIV for their experiences in receiving counseling, and acceptance of and adherence to ART. We surveyed four counseling domains (privacy, contents, frequency, and duration) and explored the key findings through in-depth interviews. In addition, 24 exit interviews and record reviews were performed. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Out of 170 PLHIV who received the counseling program, 139 (81.76%) accepted ART, and 52 (37.4%) discontinued ART in six months of follow up. Although counselors covered most of the content (16/17 components), the median time and frequency of counseling were insufficient. Despite a high score of HIV counseling provided to PLHIV in our study location, the overall acceptance of and adherence to ART remains fair or moderate. Our study suggests that counseling before ART initiation is inadequate for improving acceptance and adherence to ART in Bali Province. This reduced effectiveness is influenced by internal issues (interpersonal skills, limited technical capacity) and external factors both from PLHIV and society (stigma, disclosure, discrimination).

Perceptions dynamics about antiretroviral treatment among HIV patients in Bali

“…Our study found that perceptions of PLHIV toward outreach workers were highly positive at the time of HIV diagnosis; however, it was significantly decreased over time particularly with regard to confidentiality issues and the level of support provided by outreach workers. In addition, this finding supports the important aspect of counseling to communicate deeply about ARV drug with PLHIV to increase the successful of counseling provided by outreach workers [24]. The substantial decrease of PLHIV throughout the continum of HIV diagnosis (T1, n=170), ART initiation (T2, n=139), and three months follow-up (T3, n=102) suggests that adherence to ART is a continuous process which is influenced by the dynamics of perceptions of PLHIV about ART and the quality of HIV-related services they had received.…”

“…*Two proportion test and median test were used, alpha 0.05; **part of sociodemographic characteristics were presented in related article[24] ISSN: 2252-8806  Perceptions dynamics about antiretroviral treatment among HIV… (Anak Agung Sagung Sawitri)…”

The ALS-IEC Theory and Its Effect on Persons Living with Human Immunodeficiency Virus

“…All participants did not know who the researcher is and did not know each other but aware that they are under study. Double-blind studies are particularly useful for preventing bias due to demand characteristics or effect [20] and is considered the "gold standard" in intervention studies [21]. This is a chain referral process that allows the researcher to reach populations who are difficult to sample when using other sampling methods [22].…”