The Comorbidity of HIV, Hypertension and Diabetes: A Qualitative Study Exploring the Challenges Faced by Healthcare Providers and Patients in Selected Urban and Rural Health Facilities where the ICDM Model is Implemented in South Africa

Abstract

BackgroundPeople living with HIV (PLWH) are living longer as a result of advancement and adherence to antiretroviral therapy. As the life expectancy of PLWH increases, they are at increased risk of hypertension. MethodsWe conducted 24 in-depth interviews to understand the challenges faced by healthcare providers and PLWH with chronic comorbidities under the Integrated Chronic Disease Management (ICDM) model implemented in health facilities in South Africa. Thematic content analysis was conducted. ResultsThe challenges experienced included lack of staff capacity, unclear guidelines on the delivery of integrated care for patients with HIV chronic comorbidities, pill burden, non-disclosure, financial burden, poor knowledge of treatments, relocation of patients and access to treatment. Lack of support and integrated chronic programmes including minimal information regarding the management of HIV chronic comorbidities were another concern. ConclusionStandardised guidelines and training, increasing staff capacity and addressing socio-economic barriers is critical to achieving the outcomes of the ICDM.

INTEGRATED NCDs TREATMENT AND CARE AMONG PEOPLE LIVING WITH HIV/AIDS ATTENDING CARE AND TREATMENT AT A HEALTH FACILITY

“…The main reason for these findings is probably due to HIV care settings that do not mandate the clinician to provide NCDs care among PLHIV. As this has not been the practice, health care providers in CTC did not have up-to-date information regarding the provision of NCDs 20 care among PLHIV similar to the findings from a study done in South Africa (26). Findings from our study call for the country to ensure health care professionals providing HIV care to be well trained on providing comprehensive care that also includes NCDs care apart from focusing on only HIV services.…”

Using qualitative study designs to understand treatment burden and capacity for self-care among patients with HIV/NCD multimorbidity in South Africa: A methods paper

“… 17 - 19 Early evaluations indicate that despite efforts made through the ICDM model, chronic care is not well-integrated, staff feel unprepared and there is a lack of tools and equipment to provide adequate preventative care. 3 , 13 Patients struggle to adhere to polypharmacy, feel stigmatized and struggle to access services when living far away. 3 …”

“… 3 , 13 Patients struggle to adhere to polypharmacy, feel stigmatized and struggle to access services when living far away. 3 …”

“…It is within the context of a rising burden of people with multimorbidity and a health system that is aiming to move towards integrated, patient-centred care, that we describe the process of obtaining, analysing, and synthesizing semi-structured qualitative interviews conducted with people with HIV/NCD multimorbidity. 3 , 4 , 13 , 22 Detailing these processes and methods will allow replication by others aiming to qualitatively investigate treatment burden and capacity among people with multimorbidity in developing countries. This is important, as there is a dearth of research studies on the impact of multimorbidity among patients in South Africa and other LMICs.…”

“…1,2 This rising burden is occurring against the background of chronic infectious disease epidemics, most notably HIV and TB. 3 In the past 15 years, a steep increase in NCDs has been reported in low-income groups in South Africa, who also have the highest burden of HIV. [4][5][6][7] In addition to 8 million people receiving antiretroviral therapy (ART) in South Africa, 4 million people are living with type 2 diabetes and 18 million with hypertension.…”