Effect of Care Support Treatment and Other Factors Affecting the Intention and Adherence to Antiretroviral Therapy: Path Analysis Evidence, from Malang East Java

Fitria Diyah Ayu Pangerti, Pawito Pawito, Hanung Prasetya


Background: People living with HIV/AIDS (PLWHA) are still a health problem because of the cumulative increase in the population and there is a gap in the need for services to get antiretroviral therapy (ART). Compliance with PLHIV will consume antiretroviral drugs is a form of treatment success by being influenced by several factors encouraging to act, attitudes, intentions, perceptions of behavioral control, and care, support and treatment services (CST). The purpose of this study was to analyze the effect of CST services and other factors that influence the intention and compliance of ARV therapy, using theory of planned behavior, health belief model, and path analysis.

Subjects and Method: This was a cross sectional study conducted in Malang, East Java, from September to October 2019. A sample of 200 PLWH was selected by fixed disease sampling. The dependent variable was adherence to ARV treatment. The independent variables were intention, cues to action, attitude, perceived of behavioral control (PBC), and CST service. The data were collected by questionnaire and analyzed by path analysis run on Stata 13.

Results: Adherence to ARV therapy in PLWH was directly increased by strong intention (b= 3.12; 95% CI= 2.12 to 4.12; p<0.001). CST service was directly increased adherence to ARV therapy, but it was statistically non-significant (b= 0.19; 95% CI= -0.89 to 1.28; p= 0.293). Adherence to ARV therapy was indirectly affected by strong cues to action, positive attitude, and strong PBC.

Conclusion: Adherence to ARV therapy in PLWH is directly increased by strong intention. CST service is directly increased adherence to ARV therapy, but it is statistically non-significant. Adherence to ARV therapy is indirectly affected by strong cues to action, positive attitude, and strong PBC.

Keywords: compliance, ARV therapy, PLWH, health belief model, theory of planned behavior


Correspondence: Fitria Diyah Ayu Pangerti. Masters Program in Public Health. Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Jawa Tengah, Indonesia, 57126. Email: ayupangerti13@yahoo.com. Mobile: 081332600710

Journal of Health Promotion and Behavior (2019), 4(4): 298-305

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Adita K, Demartoto A, Pamungkasari EP (2014). Path analysis on the factors affecting people’s behavior in hiv/aids countermeasure on people living with hiv/aids (plwha) in solo plus peer support group, Surakarta. J Health Promot Behav, 2(1): 41–54. https://doi.org/10.26911/thejhpb.2017.02.01.04.

Agustin DA, Prasetyo AA, Murti B (2018). A path analysis on adherence to antiretroviral therapy among hiv/aids patients at dr. Moewardi Hospital, Surakarta using health belief model. J Health Promot Behav, 3(1): 48-55 https://doi.org/10.26911/thejhpb.2018.03.01.05.

Ajzen I (2015). Perceived behavioral control, self efficacy, locus of control, and the theory of planned behavior. J Appl Soc Psychol, 80(6): 2918–2940. doi: 10.1111/j.15591816.2002.tb00236.x.

Banas K, Lyimo RA, Hospers HJ, Ven A, Van D (2017). Predicting adherence to combination antiretroviral therapy for HIV in Tanzania: A test of an extended theory of planned behaviour model. Psychol Health. 32 (10): 1249-1265. doi:10.1080/08870446.2017.1283037.

Joglekar NS, Paranjape RS, Rahane G, Reddy S (2011). Barriers to art adherence follow ups among patients attending art centres in maharashtra, india. Indian J Med Res. 134(6): 954–959. doi: 10.4103/09715916.92642.

Kim J, Lee E, Park B, Bang JH, Lee JY (2018). Adherence to antiretroviral therapy and factors affecting low medication adherence among incident HIV-Infected individuals during 2009 – 2016: A Nationwide Study. Sci Rep. 8 (1): 3133. doi: 10.1038/s4159801821081x.

Leon C, Koosed T, Philibert B, Raposo C, Benzaken AS (2019). HIV/AIDS health services in Manaus, Brazil: patient perception of quality and its influence on adherence to antiretroviral treatment. BMC Health Serv Res, (9): –11. https://doi.org/10.1186/s1291301940629.

Mercken L, Candel M, Osch L, Van, Vries HDe (2011). No smoke without fire: The impact of future friends on adolescent smoking behaviour. Brit J Health Psych, 16:170–188. doi: 10.1348/135910710X531608.

Nelsen A, Trautner B, Petersen NJ, Gupta S, Barradas MR, Giordano TP, Naik AD (2012). Development and Validation of a Measure for Intention to Adhere to HIV Treatment. 26(6). https://doi. org/10.1089/apc.2011.0318.

Nindiyastuti NAI, Prasetya H, Murti B (2017). Determinants of mobile voluntary counselling and testing of hiv use among gay in Surakarta, Central Java. J Health Promot Behav, 3 (3): 155–165. https://doi.org/10.26911/thejhpb.2018.03.03.03.

Robin R, Mceachan C, Conner M, Taylor NJ, Robin R, Mceachan C, Taylor NJ, et al. (2011). Prospective prediction of health-related behaviours with the theory of planned behaviour: A metaanalysis. Health Psycho Rev, 5 (2): 97-144. doi: 10.1080/17437199.2010.521684.

Saal W, Kagee A (2011). The applicability of the theory of planned behaviour in predicting adherence to art among a South African sample. J Health Psychol, 17 (3): 362–370. doi: 10.1177/1359105311416875.

Samal L, Hospital W, Chander G, Medicine JH, Korthuis TP, Health O, Sharma RK (2011). Internet health information seeking behavior and antiretroviral adherence in persons living with hiv/aids. AIDS Patient Care ST, 25 (7). doi: 10.1089/apc.2011.0027.

Sulaeman ES (2016). Pembelajaran model dan teoi perilaku kesehatan konsep dan aplikasi. Surakata: UNS Press.

Sunaryo, Demartoto A, Adriyani RB (2015). Association between knowledge, perceived seriousness, perceived benefit and barrier, and family support on adherence to anti retrovirus therapy in patients with HIV/AIDS. J Health Promot Behav, 1(1): 54-61. https://doi.og/10.26911/thejhpb.2016.1.01.08.

Tarkang EE, Zotor FB (2015). Application of the health belief model (HBM) in HIV prevention: A literature review. 1 (1): 1–8. https://doi.org/10.11648/ j.cajph.20150101.11.

UNAIDS (2018). UNAIDS data 2018. programme on HIV/AIDS, 1-376. http://www.unaids.org/sites/default/media_asset/unaids-data-2017en.pdf z%0A.

Utami S (2018). HIV/AIDS dalam sustainable development goals (SDGs): insiden, permasalahan dan upaya ketercapaian di Indonesia. Universitas terbuka. 1(1): 1-22 http://www repository.ut.ac.id.

Zhou J, Tanuma J, Chaiwarith R, Lee CKC, Law MG, Kumarasamy N, Lim PL, et al. (2012). Loss to follow up in hiv-infected patients from asia-pacific. Aids Res Ther, 2012: 1-10. https://doi.org/10.1155/2012/375217.

Zhou G, Li X, Qiao S, Zhou Y, Shen Z (2017). Psychological and behavioral barriers to art adherence among plwh in China: role of self- efficacy. Aids Care, 2017:1-6. doi: 10.1080/0954.0121.2017.1327648.

Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N (2009). Religion and hiv in tanzania: influence of religious beliefs on hiv stigma, disclosure, and treatment attitudes. BMC Public Health, 12: 1–12. doi: 10.1186/14712458975.


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