“I only seek treatment when I am ill”: Experiences of hypertension and diabetes care among adults living with HIV in urban, Tanzania

Abstract

Background For adults living with HIV (ALHIV) and comorbidities, access to comprehensive healthcare services is crucial to achieving optimal health outcomes. This study aims to describe lived experiences, challenges, and coping strategies for accessing care for hypertension and/or diabetes (HTN/DM) in HIV care and treatment clinics (CTCs) and other healthcare settings. Methodology We conducted in-depth interviews with 33 ALHIV with HTN (n=16), DM (n=10), and both (n=7), purposively recruited from six HIV CTCs in Dar-es-Salaam, Tanzania. Thematic content analysis was guided by the 5As framework domains (availability, accommodation, affordability, acceptability, and accessibility). Results Participants sought HTN/DM care including screening and management at non-CTC health facilities due to the limited availability of such services at HIV CTCs. However, healthcare delivery for these conditions was perceived as unaccommodating and poorly coordinated. The need to attend multiple clinic appointments for the management of HTN/DM in addition to HIV care was perceived as frustrating, time-consuming, and financially burdensome. Participants reported difficulty paying for their HTN/DM medications and non-HIV CTCs providers’ consultation costs. High costs of care and transportation, limited understanding of comorbidities, and the perceived complexity of HTN/DM care contributed to HTN/DM treatment discontinuity among ALHIV. As a means of coping, participants frequently monitored their own HTN/DM symptoms at home. When symptoms were a problem, participants utilized community pharmacies and dispensaries near their residences to check blood pressure and sugar levels and obtain medications. These approaches were preferred to seeking care at the HTN/DM care sites due to the costs. Limited education in HTN/DM management was provided at all health facilities including HIV CTCs. Participants expressed a preference for non-pharmaceutical approaches to comorbidity management such as lifestyle modification and herbal therapies because of concerns about side effects and perceived ineffectiveness of HTN/DM medications. Participants also preferred integrated care and focused health education on multimorbidity management at HIV CTCs. Conclusion Our findings highlight significant barriers to accessing HTN/DM care among ALHIV, mostly related to affordability, availability, and accessibility. Integration of NCD care into HIV CTCs, with attention to cost and other barriers, could greatly improve ALHIV health access and outcomes and align with patient preference.