TY - JOUR
T1 - Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda
T2 - a qualitative exploration of experiences accessing an integrated care service
AU - Van Hout, Marie Claire Annette
AU - Zalwango, Flavia
AU - Akugizibwe, Mathias
AU - Namulundu Chaka, Moreen
AU - Bigland, Charlotte
AU - Birungi, Josephine
AU - Jaffar, Shabbar
AU - Bachmann, Max
AU - Murdoch, Jamie
N1 - Funding Information:
Funding: The INTE-AFRICA project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 825 698.
Publisher Copyright:
© 2022, Emerald Publishing Limited.
PY - 2023/2/7
Y1 - 2023/2/7
N2 - Purpose: Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immunodeficiency virus (HIV) in sub-Saharan Africa. Whilst there is research on integrated service experiences of women living with HIV (WLHIV) and cancer, little is known regarding those of WLHIV, diabetes and/or hypertension when accessing integrated care. Our research responds to this gap. Design/methodology/approach: The INTE-AFRICA project conducted a pragmatic parallel arm cluster randomised trial to scale up and evaluate “one-stop” integrated care clinics for HIV-infection, diabetes and hypertension at selected primary care centres in Uganda. A qualitative process evaluation explored and documented patient experiences of integrated care for HIV, diabetes and/or hypertension. In-depth interviews were conducted using a phenomenological approach with six WLHIV with diabetes and/or hypertension accessing a “one stop” clinic. Thematic analysis of narratives revealed five themes: lay health knowledge and alternative medicine, community stigma, experiences of integrated care, navigating personal challenges and health service constraints. Findings: WLHIV described patient pathways navigating HIV and diabetes/hypertension, with caregiving responsibilities, poverty, travel time and cost and personal ill health impacting on their ability to adhere to multi-morbid integrated treatment. Health service barriers to optimal integrated care included unreliable drug supply for diabetes/hypertension and HIV linked stigma. Comprehensive integrated care is recommended to further consider gender sensitive aspects of care. Originality/value: This study whilst small scale, provides a unique insight into the lived experience of WLHIV navigating care for HIV and diabetes and/or hypertension, and how a “one stop” integrated care clinic can support them (and their children) in their treatment journeys.
AB - Purpose: Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immunodeficiency virus (HIV) in sub-Saharan Africa. Whilst there is research on integrated service experiences of women living with HIV (WLHIV) and cancer, little is known regarding those of WLHIV, diabetes and/or hypertension when accessing integrated care. Our research responds to this gap. Design/methodology/approach: The INTE-AFRICA project conducted a pragmatic parallel arm cluster randomised trial to scale up and evaluate “one-stop” integrated care clinics for HIV-infection, diabetes and hypertension at selected primary care centres in Uganda. A qualitative process evaluation explored and documented patient experiences of integrated care for HIV, diabetes and/or hypertension. In-depth interviews were conducted using a phenomenological approach with six WLHIV with diabetes and/or hypertension accessing a “one stop” clinic. Thematic analysis of narratives revealed five themes: lay health knowledge and alternative medicine, community stigma, experiences of integrated care, navigating personal challenges and health service constraints. Findings: WLHIV described patient pathways navigating HIV and diabetes/hypertension, with caregiving responsibilities, poverty, travel time and cost and personal ill health impacting on their ability to adhere to multi-morbid integrated treatment. Health service barriers to optimal integrated care included unreliable drug supply for diabetes/hypertension and HIV linked stigma. Comprehensive integrated care is recommended to further consider gender sensitive aspects of care. Originality/value: This study whilst small scale, provides a unique insight into the lived experience of WLHIV navigating care for HIV and diabetes and/or hypertension, and how a “one stop” integrated care clinic can support them (and their children) in their treatment journeys.
KW - Diabetes
KW - HIV
KW - Hypertension
KW - Integrated care
KW - Non-communicable disease
KW - Uganda
KW - Women
UR - http://www.scopus.com/inward/record.url?scp=85143775570&partnerID=8YFLogxK
U2 - 10.1108/JICA-06-2022-0033
DO - 10.1108/JICA-06-2022-0033
M3 - Article
AN - SCOPUS:85143775570
SN - 1476-9018
VL - 31
SP - 86
EP - 99
JO - Journal of Integrated Care
JF - Journal of Integrated Care
IS - 1
ER -
