Addressing the Challenges with Non-Communicable Diseases among People Living with HIV: Burden, Barriers and Future Directions

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.