Addressing the Challenges with Non-Communicable Diseases among People Living with HIV: Burden, Barriers and Future Directions
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Background
Burden of Noncommunicable diseases (NCDs) among people living with HIV (PLHIV) is a significant public health challenge. This study aimed to estimate the burden of NCDs among PLHIV, including diabetes mellitus (DM), Hypertension (HTN), heart disease, stroke, cancer, and respiratory disease, also sought to identify patterns and barriers to NCD care seeking and assess feasibility of integrated HIV-NCD services.
Methods
Mixed-methods research with convergent parallel design. Quantitative cross-sectional strand among 279 systematically selected adult PLHIV in antiretroviral therapy (ART) centre, captured NCD burden and healthcare seeking behaviour. In-depth interviews (IDIs) of 10 PLHIV with NCDs and three key informant interviews (KIIs) with ART service providers, in qualitative strand explored the care seeking pattern, barriers and the potential of HIV-NCD comprehensive care.
Results
Almost 30% of PLHIV had NCDs, mostly DM and HTN. Private health care preferred for NCD management, and higher preference observed with multimorbidity. Barriers to seek care at individual, interpersonal and community-organizational level were uncovered both at public and private systems. Public healthcare was fragmented falling short of their potential for comprehensive care, and private care was often unaffordable. Stigma and discrimination continued to be pervasive, fostering fear and discouraging status disclosure during NCD management. Comprehensive HIV-NCD care was deemed necessary but complex and challenging.
Conclusions
The aging PLHIV faces a dual burden of HIV and NCD with numerous barriers to seek health care. This complex issue warrants a comprehensive HIV-NCD service within public health systems. New, patient-centred models of integrated care warrant further investigation.
What is already known on this topic
With improved life expectancy, the aging people living with HIV (PLHIV) are at risk of suffering from NCDs and subsequently the chonic nature of both HIV and NCDs can disproportionately affect them. Both diseases need sustainable health care delivery. PLHIV sometimes faces additional barriers while seeking healthcare for NCDs. However, in Indian context, the magnitude of NCDs, provision of health care delivery and barriers to seek care among the PLHIV is not well evidenced.
What this study adds
The present study revealed the magnitude of common NCDs, known risk factors to NCDs among a representative PLHIV population, attending an antiretroviral therapy (ART) centre in India. Further added the healthcare seeking behaviour of PLHIV for NCDs. Barriers to seeking NCD care for PLHIV was explored through the perspective of PLHIV and healthcare providers. The study concluded with the need of comprehensive HIV-NCD care and discuss the avenues to implement the same in Indian context.
How this study might affect research, practice or policy
At policy level the present public health system in India envisions a comprehensive chronic care model for PLHIV suffering from NCDs. However, implementation challenges exist. In practice, addressing fragmentation within the existing system can be seen as an opportunity to improve NCD interventions for PLHIV. Further research into implementing new models of comprehensive HIV-NCD care within the available healthcare resources is warranted through the current findings.
