Patients’ Experiences of Comorbid HIV/AIDS and Diabetes Care and Management in Soweto, South Africa

Abstract

More people with HIV live in South Africa than anywhere else in the world. As people with HIV increasingly confront comorbid conditions, such as Type 2 diabetes, the need for integrated chronic care continues to grow. However, chronic care for patients with multimorbidities is limited in many public hospitals in South Africa. This ethnographic study describes patients’ experiences seeking care for comorbid HIV and diabetes at a public tertiary hospital in Soweto, South Africa, and self-management at home. Findings illustrate how fragmented care, multiple clinic appointments, conflicting information, and poor patient–provider communication impeded patients’ access to care for their multimorbidities. Socio-economic factors such as poverty, costly transport to the hospital, and food insecurity impeded management of multimorbidities. Integrated care for patients with multimorbidities in Soweto is imperative and must recognize the critical role social and economic conditions play in shaping the experiences of living with HIV, diabetes, and their overlap.

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

“…16 The healthcare workers perceptions of patient perspectives regarding moderating factors of implementation fidelity of the ICDM model. 32 Bosire 24 The ICDM model 32 and WHO's definition:: "the organisation, management and coordination of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money." Knight et al 26 The ICDM model 32 and Chronic Care…”

“…or living in informal settlements 21 with limited financial resources. 24 In the study by Lebina et al, 23 the patient characteristics were not available and therefore not included, because the measure of the participants' responsiveness with regard to was assessed by measuring staff's perceptions of patient responsiveness.…”

Pathways to Care for Patients With Type 2 Diabetes and HIV/AIDS Comorbidities in Soweto, South Africa: An Ethnographic Study

“…Although patients with HIV can be managed at PHC clinics, those with T2DM are mostly referred to a tertiary hospital. 37 This is because of systemic challenges such as staff shortages, untrained nurses at PHC clinics, lack of equipment and medical supplies, and poor outcomes. Such systemic barriers were also found in a Cape Town study that reported 2 separate clinics for patients with T2DM and HIV even within PHC clinics.…”

“…[38][39][40] Such findings align with what was found at the tertiary hospital in Soweto. 36,37 To bolster integration of chronic care through the health system therefore requires more investment in detection, diagnosis, treatment of NCDs alongside and in tandem with HIV care at the PHC level. 11 This will reduce cost, improve care, and enhance patient outcomes.…”

“…[47][48][49] Ultimately, health care providers rarely provided personalized support to patients or their caregivers due to workload, language barriers, and time constraints, similar to what we have reported elsewhere. 36,37 This situation occurred despite many health care providers recognizing the need for personalized support; health systems inherently contained barriers that impeded this integrated care. Patient support was provided apart from clinical interactions and primarily in group forums.…”