‘Blood pressure can kill you tomorrow, but HIV gives you time’: illness perceptions and treatment experiences among Malawian individuals living with HIV and hypertension

Abstract

Non-communicable diseases like hypertension are increasingly common among individuals living with HIV in low-resource settings. The prevalence of hypertension among people with HIV in Malawi, e.g. has been estimated to be as high as 46%. However, few qualitative studies have explored the patient experience with comorbid chronic disease. Our study aimed to address this gap by using the health belief model (HBM) to examine how comparative perceptions of illness and treatment among participants with both HIV and hypertension may affect medication adherence behaviours. We conducted semi-structured interviews with 75 adults with HIV and hypertension at an urban clinic in Lilongwe, Malawi. Questions addressed participants’ experiences with antiretroviral and antihypertensive medications, as well as their perspectives on HIV and hypertension as illnesses. Interviews were performed in Chichewa, transcribed, translated into English and analysed using ATLAS.ti. Deductive codes were drawn from the HBM and interview guide, with inductive codes added as they emerged from the data. Self-reported medication adherence was much poorer for hypertension than HIV, but participants saw hypertension as a disease at least as concerning as HIV—primarily due to the perceived severity of hypertension’s consequences and participants’ limited ability to anticipate them compared with HIV. Differences in medication adherence were attributed to the high costs of antihypertensive medications relative to the free availability of antiretroviral therapy, with other factors like lifestyle changes and self-efficacy also influencing adherence practices. These findings demonstrate how participants draw on past experiences with HIV to make sense of hypertension in the present, and suggest that although patients are motivated to control their hypertension, they face individual- and system-level obstacles in adhering to treatment. Thus, health policies and systems seeking to provide integrated care for HIV and hypertension should be attentive to the complex illness experiences of individuals living with these diseases.

“It’s because I think too much”: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania

“…In addition, the barriers described by our participants were actually quite similar to the barriers faced by the general population, however, PLHIV must also navigate HIV-related stigma and multiple siloed care systems to treat both their HIV and hypertension. Our findings are consistent with other qualitative studies exploring hypertension care barriers among PLHIV in similar settings [18,21], and signify the critical role of the HIV clinic. Given that patients are routinely engaged in and committed to their HIV care, this setting represents an ideal opportunity to improve access of chronic disease care, beyond HIV.…”

“…This study explored hypertension care perspectives and experiences among hypertensive adults engaged in HIV care in northern Tanzania. To our knowledge, only two other qualitative studies have previously described hypertension care experiences among patients with HIV in SSA [18,21]. Participants in our study described barriers unique to PLHIV including HIVrelated stigma, siloed health systems, and burden from having multiple medical conditions.…”

“…In order to design interventions that address challenges unique to this patient population, it is crucial to understand the experiences of PLHIV who have navigated hypertension treatment. However, other than a few studies [18][19][20][21][22], the barriers to hypertension awareness, treatment and control among HIV-infected adults in SSA remain largely unexplored. To better understand barriers to hypertension management among PLHIV, we conducted a qualitative study exploring the perspectives and experiences of patients with both HIV and hypertension in northern Tanzania.…”

Lived experiences of human immunodeficiency virus and hypertension in the Eastern Cape, South Africa

“… 7 , 8 , 9 The established link and rise of hypertension amongst PLWH on chronic medication is also reported to be correlated with poor medication compliance. 10 , 11 In addition, non-adherence to chronic medication, in particular in NCDs, tuberculosis and HIV, is a problem that is continuing to increase. 12…”

The State of Health Policy and Systems Research: Reflections From the 2018 5th Global Symposium

“…of aid for nutrition programmes, Khalid et al, 2019), as well as studies from the national and local levels. They address service-specific concerns, such as antibiotic use (Hadley et al, 2019), and medicine adherence for HIV and hypertension (Hing et al, 2019); but also cross-cutting system-level issues such as quality of care and health worker performance. The research presented in these papers applies a variety of methods including quantitative analysis of large datasets, systematic literature review and qualitative methods such as focus groups, semi-structured interviews and document review.…”