Barriers to Antiretroviral Therapy Adherence in Rural and Urban Areas in Indonesia: Perspectives of People Living with HIV and Healthcare Professionals.

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving the health outcomes of people living with HIV (PLHIV). However, many barriers limit PLHIV from starting and adhering to ART, which explains why HIV responses in many settings, including Indonesia, have produced limited gains. This qualitative phenomenological study explored multilevel barriers to ART adherence in urban Yogyakarta (locally known as Jogja) and rural Belu, Indonesia, from the perspectives of PLHIV and healthcare professionals (HCPs). Data were collected through one-on-one in-depth interviews with 92 PLHIV and 20 HCPs. Participants were recruited using the snowball sampling technique. Data were analysed using framework analysis informed by the Access to Healthcare Framework. The findings showed that PLHIV in Belu and Jogja had different experiences in terms of the provision of and ability to access and adhere to ART or HIV treatment. In rural Belu, ART was less available and visible, harder to approach, often unaffordable, less aligned with patients' needs, and strongly influenced by the widespread use of traditional medicine. PLHIV in Belu also reported a more limited ability to perceive the need for ART, reach services, pay costs, engage in care, and seek ART than those in urban Jogja. Personal, psychological, and social barriers were also reported to hinder PLHIV's ART adherence in both settings. These findings highlight the need for HIV policies that promote the equitable distribution of ART services and targeted interventions to improve understanding and acceptance of HIV care among PLHIV and the wider community.