A Socio-Ecological Perspective on Linkage to HIV Care in Bandung, Indonesia: A Qualitative Study to Explore Barriers and Facilitators.

Objective: This study aimed to explore the barriers and facilitators of the linkage to care in Bandung, Indonesia. Methods: This study used a descriptive qualitative design with in-depth interviews with 17 purposively selected participants, including people living with HIV (PLHIV), healthcare providers, case managers, and community health volunteers. Data were collected from September 2024 to December 2024 in three key service settings in Bandung. A socio-ecological framework guided data collection and deductive content analysis, allowing thematic categorization at the individual, interpersonal, healthcare system/policy, and community levels. Results: The analysis identified 10 main categories and 22 subcategories of facilitators and barriers linked to HIV care across socio-ecological levels. At the individual level, psychological readiness, HIV-related knowledge and perceptions, clinical conditions, and socioeconomic status shaped the linkage to care. Interpersonal support from family members, peers, and healthcare providers affected the decisions linked to care. At the healthcare system and community levels, service accessibility, stigma, and community engagement under the ongoing implementation of Universal Health Coverage (UHC) influenced the linkage to care in Bandung. A unique aspect of the present study lies in its emphasis on community engagement in the context of the ongoing implementation of UHC as a key facilitator, and service gaps at the primary care level and persistent stigma remains a key barriers in Bandung. Conclusion: Multi-level factors shaped the linkage to HIV care in Bandung. Strengthening nurse- and peer-led navigation, expanding primary care services, promoting community participation, and scaling up structured professional guidance are key to reducing stigma and improving early engagement.