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Hutahaean BSH, Stutterheim SE, Jonas KJ. Religion, Faith, and Spirituality as Barriers and Facilitators to Antiretroviral Therapy Initiation Among People with HIV in Indonesia. AIDS Patient Care STDS 2025; 39:160-172. [PMID: 39973178 DOI: 10.1089/apc.2024.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
Indonesia is a country deeply rooted in religion, faith, and spirituality. These aspects significantly determine individuals' decision-making and behavior, including health care decisions. Given the suboptimal attainment of the HIV-cascade targets in the country, we conducted a study to explore the role of religion, faith, and spirituality on antiretroviral therapy (ART) initiation. Our study involved individual interviews with 67 participants recruited from community health centers, public hospitals, and private clinics, predominantly Muslim, including 17 untreated people with HIV (ART-naïve), 30 people with HIV on treatment (ART-experienced), and 20 HIV service providers. Findings revealed that many individuals perceived HIV as a godly punishment related to individual failure (prior risk-prone behaviors), generating shame, guilt, and stigma. Perceiving religion as punitive and unforgiving and holding fatalistic beliefs was linked to postponed ART initiation. Conversely, perceiving religion as loving and forgiving, seeking forgiveness through religious practices, viewing ART intake as a "collaborative" effort with God, and engaging in righteous deeds facilitated ART initiation. These findings indicated that religion, faith, and spirituality can serve as both barriers and facilitators to ART initiation, depending on individuals' faith-based practices and perceptions of religion, whether punishing or forgiving. We recommend that people with HIV and health care providers better recognize the role of religion, faith, and spirituality in coping with shame, guilt, and stigma after an HIV diagnosis. This recognition can facilitate informed decisions regarding ART initiation, ultimately improving health outcomes for individuals with HIV in Indonesia.
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Affiliation(s)
- Bona S H Hutahaean
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychology, Universitas Indonesia, Depok, Indonesia
| | - Sarah E Stutterheim
- Department of Health Promotion & Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Merati TP, Yunihastuti E, Wisaksana R, Kurniati N, Arlinda D, Karyana M, Susanto NH, Lokida D, Kosasih H, Diana A, Bang LE, Setiyaningrum M, Amin DM, Eppy E, Cahyawati WASN, Danudirgo EW, Darmaja IMG, Farhanah N, Gunawan CA, Hadi U, Jamil KF, Katu S, Kembaren T, Kosa IGR, Norosingomurti DL, Purnama A, Laksanawati IS, Rusli A, Somia IKA, Subronto YW, Toruan IL, Ridzon R, Liang CJ, Neal AT, Chen RY. A prospective observational cohort study of HIV infection in Indonesia: baseline characteristics and one-year mortality. BMC Infect Dis 2025; 25:87. [PMID: 39833697 PMCID: PMC11748832 DOI: 10.1186/s12879-024-10354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 12/13/2024] [Indexed: 01/22/2025] Open
Abstract
INTRODUCTION The incidence rate of newly diagnosed HIV infection in Indonesia decreased from 21 per 100,000 in 2011 to 10 per 100,000 in 2021. Despite this progress, AIDS-related deaths among people living with HIV (PLWH) increased from 3.4% in 2010 to 4.8% in 2020. Determining risk factors for mortality may identify areas to intervene and reduce mortality. METHODS A multicenter, prospective, observational cohort study of HIV infection, coinfections, and comorbidities (INA-PROACTIVE) was carried out at 19 hospitals across major islands in Indonesia. The study enrolled PLWH from 2018-2020 and followed them for 3 years. For this analysis, PLWH ≥ 18 years old with one year of follow-up data were included. Cox regression was used to identify variables at enrollment that correlated with one-year mortality. RESULTS Among the 4,050 PLWH analysed in the study, 68.8% were male, 53.5% acquired HIV through heterosexual transmission, 92.4% were on antiretroviral treatment (ART) at enrollment, and 72.4% had an undetectable viral load. At one year, 115 (2.8%) had died. Detectable viremia at enrollment was significantly associated with mortality, with the risk increasing as the viral load (VL) category increased (adjusted hazard ratio [aHR] 4.47, 95% CI: 1.47-13.56 for VL 50 to < 1,000 copies/mL; aHR 7.88, 95% CI: 2.80-22.20 for VL 1,000 to 10,000 copies/mL; and aHR 18.33, 95% CI: 7.94-42.34 for VL > 10,000 copies/mL; compared to VL < 50 copies/mL). Other factors at enrollment significantly associated with mortality were a CD4 + count < 200 (aHR 8.02, 95% CI: 2.69-23.86; compared to ≥ 350), age 40-49 years (aHR 2.19, 95% CI 1.23-3.87; compared to 18-29 years) and being underweight (aHR 1.84, 95% CI: 1.18-2.85; compared to normal weight). CONCLUSIONS Among predominantly treatment-experienced PLWH, detectable viremia and continued immunosuppression were significantly associated with one-year mortality. This study highlights the importance of ART with complete viral suppression as well as immune recovery to prevent mortality. TRIAL REGISTRATION Clinical Trial Number: NCT03663920, registration date: 4 January 2018.
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Affiliation(s)
- Tuti P Merati
- Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Evy Yunihastuti
- Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Central Jakarta, Indonesia
| | - Rudi Wisaksana
- Faculty of Medicine, Hasan Sadikin General Hospital, Universitas Padjadjaran, Bandung, Indonesia
| | - Nia Kurniati
- Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Central Jakarta, Indonesia
| | - Dona Arlinda
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia.
- Health Policy Agency, Ministry of Health, Central Jakarta, Indonesia.
| | - Muhammad Karyana
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
- Health Policy Agency, Ministry of Health, Central Jakarta, Indonesia
| | - Nugroho H Susanto
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Dewi Lokida
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Lois E Bang
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Melinda Setiyaningrum
- Indonesia Research Partnership On Infectious Diseases (INA-RESPOND), Central Jakarta, Indonesia
| | - Desrinawati M Amin
- Prof. Dr. Sulianti Saroso Infectious Disease Hospital, North Jakarta, Indonesia
| | - Eppy Eppy
- Persahabatan Central General Hospital, East Jakarta, Indonesia
| | | | | | | | - Nur Farhanah
- Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro/Dr, Kariadi Hospital, Semarang, Indonesia
| | - Carta A Gunawan
- Faculty of Medicine, Abdoel Wahab Sjahranie General Hospital, Universitas Mulawarman, Samarinda, Indonesia
| | - Usman Hadi
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga/Dr, Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Kurnia F Jamil
- Dr. Zainoel Abidin Hospital/Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Sudirman Katu
- Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | | | | | | | - Asep Purnama
- Dr. T. C. Hillers Public Hospital, Maumere, Indonesia
| | - Ida S Laksanawati
- Department of Child Health, Dr. Sardjito General Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adria Rusli
- Prof. Dr. Sulianti Saroso Infectious Disease Hospital, North Jakarta, Indonesia
| | - I Ketut Agus Somia
- Department of Internal Medicine, Faculty of Medicine, Ngoerah Hospital, Universitas Udayana, Denpasar, Indonesia
| | - Yanri W Subronto
- Department of Internal Medicine/Magister of Tropical Medicine Study Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia
| | | | - Renee Ridzon
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - C Jason Liang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Aaron T Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Ray Y Chen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
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Hutahaean BSH, Stutterheim SE, Jonas KJ. The role of fear as a barrier and facilitator to antiretroviral therapy initiation in Indonesia: insights from patients and providers. AIDS Care 2025; 37:161-177. [PMID: 39402857 DOI: 10.1080/09540121.2024.2414080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 10/01/2024] [Indexed: 12/30/2024]
Abstract
Initiating antiretroviral therapy (ART) in Indonesia poses major challenges, with limited studies on specific ART initiation barriers and facilitators. Using a socioecological approach, we explored, through semi-structured interviews, the perspectives of 67 participants: 17 people with HIV not (yet) on ART, 30 people with HIV on treatment, and 20 HIV service providers (HSPs). Fears emerged as pervasive barriers to initiation encompassing, at the intrapersonal level, (irrational) fears of negative medical and non-medical consequences. At the health system level, fears were linked to concerns about bureaucracy and insufficient universal coverage. On a societal level, fears stemmed from prevalent myths, misinformation on social media, and the impact of COVID-19. Interestingly, fear also served as a facilitator to initiation. At the intrapersonal level, initiation was driven by a fear of deteriorating health or death due to AIDS-related conditions. At the interpersonal level, buddies and HSPs leveraged to motivate initiation. At the societal level, accurate yet fear-inducing information on social media stimulated initiation. Perspectives differed between people with HIV and HSP, with people with HIV emphasizing barriers on intrapersonal to health system levels, while HSP focused mostly on intrapersonal and interpersonal barriers, albeit recognizing the crucial role of health systems.
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Affiliation(s)
- Bona S H Hutahaean
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Psychology, Universitas Indonesia, Depok, Indonesia
| | - Sarah E Stutterheim
- Department of Health Promotion & Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Wahyuningsih R, Adawiyah R, Sjam R, Prihartono J, Ayu Tri Wulandari E, Rozaliyani A, Ronny R, Imran D, Tugiran M, Siagian FE, Denning DW. Serious fungal disease incidence and prevalence in Indonesia. Mycoses 2021; 64:1203-1212. [PMID: 33971053 DOI: 10.1111/myc.13304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Indonesia is a tropical country, warm and humid, with numerous environmental fungi. Data on fungal disease burden help policymakers and clinicians. OBJECTIVES We have estimated the incidence and prevalence of serious fungal diseases. METHODS We found all published and unpublished data and estimated the incidence and prevalence of fungal diseases based on populations at risk. HIV data were derived from UNAIDS (2017), pulmonary tuberculosis (PTB) data from 2013-2019, data on chronic pulmonary aspergillosis (CPA) were used to estimate CPA prevalence and likely deaths, COPD data from Hammond (2020), lung cancer incidence was from Globocan 2018, and fungal rhinosinusitis was estimated using community data from India. RESULTS Overall ~7.7 million Indonesians (2.89%) have a serious fungal infection each year. The annual incidence of cryptococcosis in AIDS was 7,540. Pneumocystis pneumonia incidence was estimated at 15,400 in HIV and an equal number in non-HIV patients. An estimated 1% and 0.2% of new AIDS patients have disseminated histoplasmosis or Talaromyces marneffei infection. The incidence of candidaemia is 26,710. The annual incidence of invasive aspergillosis was estimated at 49,500 and the prevalence of CPA is at 378,700 cases. Allergic bronchopulmonary aspergillosis prevalence in adults is estimated at 336,200, severe asthma with fungal sensitisation at 443,800, and fungal rhinosinusitis at 294,000. Recurrent vulvovaginal candidiasis is estimated at 5 million/year (15-50 years old). The incidence of fungal keratitis around 40,050. Tinea capitis prevalence in schoolchildren about 729,000. CONCLUSIONS Indonesia has a high burden of fungal infections.
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Affiliation(s)
- Retno Wahyuningsih
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Department of Parasitology, Universitas Kristen Indonesia, School of Medicine, Jakarta, Indonesia
| | - Robiatul Adawiyah
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ridhawati Sjam
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Joedo Prihartono
- Department of Community Medicine Universitas Indonesia, Faculty of Medicine, Jakarta, Indonesia
| | | | - Anna Rozaliyani
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Robertus Ronny
- Department of Parasitology, Universitas Kristen Indonesia, School of Medicine, Jakarta, Indonesia
| | - Darma Imran
- Department of Neurology, Universitas Indonesia, Faculty of Medicine/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mulyati Tugiran
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Forman E Siagian
- Department of Parasitology, Universitas Kristen Indonesia, School of Medicine, Jakarta, Indonesia
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Tarigan YN, Woodman RJ, Miller ER, Wisaksana R, Ward PR. Impact of strategic use of antiretroviral therapy intervention to the HIV continuum of care in 13 cities in Indonesia: an interrupted time series analysis. AIDS Res Ther 2021; 18:22. [PMID: 33902631 PMCID: PMC8074419 DOI: 10.1186/s12981-021-00340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background In 2013 the Indonesian government introduced the strategic use of antiretroviral therapy (SUFA) initiative of expanding access to HIV test and treatment, to help achieve the UNAIDS 90–90–90 targets. However, there has been no comprehensive evaluation of the impact of this intervention in Indonesia. We conducted an interrupted time series (ITS) analysis across 6-years to assess its immediate and medium-term impact. Methods Monthly aggregated HIV data from all HIV care clinics for persons aged ≥ 15 years were collected from 13 pilot cities. The data period encompassed 3-years prior to SUFA (26 Dec 2010–25 Dec 2013) and 3-years post-SUFA (26 Dec 2013–25 Dec 2016). The ITS was performed using a multilevel negative binomial regression model to assess the immediate and trend changes in each stage of the HIV continuum of care. Results In the pre-SUFA period, the overall coverage in the respective risk populations for HIV tests, cases, enrolments, eligible cases and ARV initiation were 1.0%, 8.6%, 98.9%, 76.9% and 75.8% respectively. In the post-SUFA period coverage was 3%, 3.8%, 98.6%, 90.3% and 81.2% respectively—with a significant increase in the median number of HIV tests, HIV cases, those eligible for ARV treatment and treatment initiation (p < 0.05 for each). The ITS analysis demonstrated immediate increases in HIV tests (IRR = 1.41, 95% CI 1.25, 1.59; p < 0.001) and an immediate decrease in detected HIV cases per person tested (IRR = 0.77, 95% CI 0.69–0.86; p < 0.001) in the month following commencement of SUFA. There was also a 3% decline in the monthly trend for HIV tests performed (IRR = 0.97; 95% CI 0.97–0.98, p < 0.001), a 1% increase for detected cases (IRR = 1.01, 95% CI 1.0–1.02, p < 0.001), and a 1% decline for treatment initiation (IRR = 0.99,95% CI 0.99–1.0 p < 0.05). Conclusions SUFA was associated with an immediate and sustained increase in the absolute number of HIV tests performed, detected HIV cases, and close to complete coverage of detected cases that were enrolled to care and defined as eligible for treatment. However, treatment initiation remained sub-optimal. The findings of this study provide valuable information on the real-world effect of accelerating ARV utilizing Treatment as Prevention for the full HIV continuum of care in limited resource countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00340-4.
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