A PRECEDE–PROCEED MODEL ON THE DETERMINANTS OF ADHERENCETO HIV TREATMENT: A PATH ANALYSIS EVIDENCE FROM INDONESIA

Abstract

Objective: Adherence is increasingly recognized as an important determinant of successful HIV treatment (also called antiretroviral therapy [ART]). Poor adherence may cause ART failure and increase the risk of drug resistance. No prior studies have explained the reasons for poor adherence to ART among HIV-infected patients in Indonesia. This study aimed to investigate the determinants of adherence to ART among HIV-infected patients using precede–proceed model and path analysis. Methods: This was an analytic observational study with a cross-sectional design. The study was carried out at Dr. Moewardi Hospital, Surakarta, Central Java, Indonesia, from January to March 2018. A total of 284 HIV-infected patients visiting Dr. Moewardi Hospital for ART was selected for this study by simple random sampling. The dependent variable was adherence to ART. The independent variables included adverse effect, patient knowledge, income, depression, trust in provider, ART supply by the government, family support, stigma, discrimination, distance, and travel expenditure. The data were collected by pre-tested questionnaire and analyzed by path analysis. Results: Adherence to ART was directly and positively affected by government supply of ART (b=2.10; 95% confidence interval (CI)=0.85–3.36; p<0.001), patient knowledge (b=1.70; 95% CI= 0.43–2.95; p=0.008), and trust in provider (b=2.14; 95% CI=−0.58–4.87; p = 0.123). Adherence was directly but negatively affected by adverse effect (b=−4.17; 95% CI=−6.87–−1.47; p=0.879), depression (b=−2.38; 95% CI=−4.15–−0.62; p=0.002), stigma (b=−4.10; 95% CI=−6.49–−1.71; p=0.008), and travel expenditure (b=−1.52; 95% CI=−2.68 to −0.36; p<0.001). Conclusion: Adherence is indirectly and positively affected by patient satisfaction, income, family support, but indirectly and negatively affected by discrimination and distance. This study concludes that government supply of ART, patient knowledge, and trust in provider, positively affect adherence to ART. Adverse effect, depression, stigma, and travel expenditure negatively affect adherence.