Self-awareness as the key to successful adherence to antiretroviral therapy among people living with HIV in Indonesia: A grounded theory study

Background: Adherence to antiretroviral therapy (ART) continues to pose a significant
challenge for people living with HIV (PLWH). Non-adherence to ART can have far-reaching
implications for patient well-being, particularly in increasing the risk of opportunistic infections
when medication is not taken as prescribed.
Objective: This study aimed to develop a theoretical model that explains how PLWH in
Indonesia adhere to their ART regimen and the strategies they follow to maintain adherence.
Methods: The study used a grounded theory approach. Data were collected through face-toface in-depth interviews with 21 PLWH who had been taking ART for six months or more at a
non-governmental organization (NGO) in Jakarta, Indonesia, between July 2019 and
November 2019. Theoretical sampling was used, and the data analysis method of Corbin and
Strauss was utilized, including open coding, axis coding, and selective coding.
Results: Three stages were identified as a process of adherence to the ART regimen: 1)
initiating ART, 2) missing the connection, and 3) taking control. Self-awareness was identified
as the central core theme describing the ART adherence process.
Conclusion: Having adequate self-awareness to take ART regularly is crucial to improving
adherence to ART. Moreover, social support from one’s spouse and family members can help
patients maintain adherence. Therefore, self-awareness and support systems should be
included as components in nursing interventions when starting ART therapy. In addition,
nurses can help identify potential support persons and provide information related to ART
therapy.