Perceived Barriers Outweigh Perceived Benefits in Predicting Lost to Follow-Up Among HIV Patients on ART: A Health Belief Model Study in Semarang

Abstract

Background: Retaining patients diagnosed with Human Immunodeficiency Virus in lifelong treatment is critical, yet many discontinue care. This study aimed to identify factors associated with lost-to-follow-up behavior among patients receiving antiretroviral therapy in Semarang, Indonesia, using constructs from the Health Belief Model.

Methods: A quantitative cross-sectional study was conducted at a primary health center involving seventy-seven eligible respondents. Data on perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy were analyzed using correlation tests.

Results: The findings demonstrated that perceived barriers constituted the strongest predictor of care discontinuation with strong statistical significance. Other constructs, including perceived susceptibility, perceived severity, cues to action, and self-efficacy, also showed significant moderate associations with patient retention. Conversely, the perceived benefits of treatment did not significantly influence behavior. While patients recognized the advantages of medication, structural and psychosocial obstacles such as stigma, transportation costs, and time constraints dictated their actions.

Conclusion: The negative impact of perceived barriers fundamentally outweighs the protective influence of understanding treatment benefits. Improving treatment retention requires robust preventive interventions, proactive community screening programs, and performance- and risk-based capitation models to actively dismantle systemic obstacles at the primary healthcare level, rather than solely educating patients about clinical benefits.