Introduction
Methods
Search strategy
Inclusion and exclusion criteria
Study screening and selection
Quality appraisal
Data extraction
Data synthesis
Confidence in the findings
Results
Literature search
Quality appraisal
C1 | C2 | C3 | C4 | C5 | C6 | C7 | C8 | C9 | C10 | |
---|---|---|---|---|---|---|---|---|---|---|
Abele [17] (2018) | U | Y | Y | Y | Y | U | Y | Y | Y | Y |
Bosire et al. [18] (2020) | U | Y | Y | Y | Y | Y | U | Y | Y | Y |
Bosire [21] (2020) | U | Y | Y | Y | Y | U | U | Y | Y | Y |
Corrigan et al. [22] (2020) | U | Y | Y | Y | Y | U | U | Y | Y | Y |
Gonah et al. [23] (2020) | U | Y | Y | Y | Y | U | U | Y | Y | Y |
Hing et al. [24] (2020) | U | Y | Y | Y | Y | U | Y | Y | Y | Y |
Mendenhall et al. [25] (2019) | U | Y | Y | Y | Y | Y | Y | Y | Y | Y |
Monroe et al. [26] (2013) | U | Y | Y | Y | Y | U | U | Y | U | Y |
Morgan et al. [27] (2018) | U | Y | Y | Y | Y | U | Y | Y | Y | Y |
Muiruri et al. [28] (2020) | U | Y | Y | Y | Y | U | U | Y | Y | Y |
Peer et al. [29] (2020) | U | Y | Y | Y | Y | U | U | Y | Y | Y |
Simonik et al. [30] (2016) | U | Y | Y | Y | Y | U | U | Y | Y | Y |
Slomka et al. [31] (2017) | U | Y | Y | Y | Y | U | U | Y | U | Y |
Warren-Jeanpiere et al. [32] (2014) | U | Y | Y | Y | Y | U | U | Y | U | Y |
Study description
Study (year), Country | Design (data collection method) | Phenomenon of interest | Recruitment and participants | Main findings |
---|---|---|---|---|
Abele [17] (2018), US | Phenomenological study (in-depth interviews) | To explore the experience of PLWH aged over 50 living with HIV and comorbidities. | Participants: 10 PLWH aged over 50; Mean age: 60.5 yrs.; Male: 80%; Comorbidities: at least 1 type of comorbidity; Race: not specific; Participants were recruited from an HIV agency in the US and an online HIV community. | Three themes were identified: 1) from fear of the unknown to ownership; 2) from ownership to survival; and 3) the constant struggle of surviving with HIV. |
Bosire et al. [18] (2020), South Africa | Case study (narrative interviews) | To explore how women address multiple chronic and infectious diseases. | Participants: 3 women PLWH; Age: 30–45 yrs.; Male: 0%; Race: Black; Comorbidities: two participants living with breast cancer, hypertension, and HIV; Patients were recruited from a cancer study in South Africa. | One theme was identified in PLWH: social and economics of family. |
Bosire [21] (2020), South Africa | Ethnographic study (narrative interviews) | To describe the experiences of PLWH seeking care for comorbid HIV and diabetes in a hospital in South Africa. | Participants: 15 PLWH; Age: 40–70 yrs.; Male: 46.6%; Race: Black; Comorbidity: Type 2 diabetes; Economic status: more than half of PLWH were unemployed with $60.72–$121.45 income per month; Participants were recruited from one diabetes clinic at a tertiary hospital in South Africa. | Two themes were identified: 1) patients’ experiences accessing chronic care and 2) patients’ experiences of self-management at home. |
Corrigan et al. [22] (2020), US | Descriptive study (semistructured interviews) | To explore the perception of cancer care experience among PLWH. | Participants: 27 PLWH; Median age: 56 yrs.; Male: 81.5%; Race: 70.4% were African American, 25.9% were Caucasian, and 3.7% were Hispanic/Latino; Comorbidity: cancer; Economic status: median annual household income was $24,000; Participants at different stages in the cancer care process were recruited by using DEDUCE software and electronic medical records. | Eight types of barriers to care were identified: 1) side effects from treatment; 2) stigma; 3) accessibility issues; 4) financial burden of cancer treatment; 5) emotional and mental health difficulties; 6) family or personal issues; 7) mistrust in providers; and 8) fear of cancer diagnosis and treatments. |
Gonah et al. [23] (2020), South Africa | Descriptive study (key informant interviews and focus group discussions) | To identify the challenges and ways of coping of PLWH with comorbid hypertension and diabetes mellitus accessing care. | Participants: 8 health managers and 72 PLWH; Age: 50% aged 30–49 yrs. and 50% aged > 50 yrs.; Male: 33.3%; Comorbidities: hypertension and/or diabetes mellitus); All participants were recruited from six ART sites in South Africa. | Three themes were identified: 1) management of hypertension and diabetes mellitus; 2) capacity to screen hypertension and diabetes mellitus; and 3) capacity to treat hypertension and diabetes mellitus. |
Hing et al. [24] (2019), Malawi | Phenomenological study (semistructured interviews) | To explore the experience and perception of HIV and hypertension among PLWH. | Participants: 75 PLWH; Median age: 53 yrs.; Male: 36%; Comorbidity: hypertension; Participants were recruited from an HIV treatment site in Malawi. | Six themes were identified: 1) perceived susceptibility to comorbidities; 2) perceived severity of comorbidities; 3) perceived benefits of controlling comorbidities; 4) perceived barriers to controlling comorbidities; 5) perceived self-efficacy in controlling comorbidities; and 6) cues to action for controlling comorbidities. |
Mendenhall et al. [25] (2019), South Africa | Phenomenological study (narrative interviews) | To explore how Black South Africans perceive and experience multiple concurrent medical conditions. | Participants: 80 participants with multimorbidities; Mean age: 56 yrs.; Male: 37.5%; Economic status: median monthly income was $196; Comorbidities: various types of comorbidities, including hypertension, HIV, obesity, diabetes, tuberculosis, arthritis, chronic pain, depression, and anxiety; Participants were recruited from two hospitals in South Africa. | Five themes regarding HIV and comorbidities were identified: 1) complexity of multimorbidities; 2) defining sickness and health; 3) understanding cancer; 4) differentiating between conditions; and 5) managing multiple conditions. |
Monroe et al. [26] (2013), US | Phenomenological study (focus group) | To explore perspectives of living with HIV and diabetes mellitus or hypertension among PLWH and the factors affecting their medication adherence. | Participants: 35 PLWH; Mean age: 51 yrs.; Male: 54%; Race: Black 94%; Comorbidity: diabetes or hypertension; Participants were recruited through self-referrals from flyers and through referrals from medical providers in one HIV clinic in the US. | Four themes were identified: 1) comorbidities generate concern and frustration; 2) understanding health conditions and medications promotes adherence; 3) simpler regimens with fewer side effects promote adherence; and 4) untreated substance abuse and mental health issues hinder adherence. |
Morgan et al. [27] (2018), Ghana | Phenomenological study (semistructured interviews) | To explore the perceptions and experiences of women living with multimorbidity in Ghana. | Participants: 20 women participants with multimorbidity Mean age: 56 yrs.; Male: 0%; Economic status: 60% were employed; Comorbidity: HIV was the most common condition among the participants; Participants were recruited from three polyclinics in Ghana. | Four themes emerged: 1) the influences on patients’ health experience; 2) seeking care and the responsiveness of the health care system; 3) how patients manage health care demands; and 4) outcomes due to health. |
Muiruri et al. [28] (2020), US | Descriptive study (semistructured interviews and focus group discussion) | To identify the factors associated with adherence to cardiovascular disease (CVD) medications among PLWH with viral suppression. | Participants: 51 PLWH taking ART and CVD medications Mean age: 57 yrs.; Male: 66.7%; Race: Africa American 60.8%; Economic status: Monthly income $983; Participants were recruited from three hospitals in the US. | Three main themes were identified: 1) CVD prevention preferences and practices; 2) impact of long-term HIV care on adherence to CVD medication; and 3) factors motivating the adoption of and adherence to heart healthy behaviors |
Peer et al. [29] (2020), South Africa | Mix-methods study (focus group and in-depth and semistructured interviews) | To explore the perceptions and experiences of PLWH with hypertension and identify their healthcare providers’ experiences interacting with patients with multiple comorbidities in South Africa. | Participants: 55 PLWH, 11 clinicians, 10 specialized nursing professionals, and 12 lay counselors; Comorbidity: hypertension; Participants were recruited from 17 public healthcare facilities in South Africa. | Four themes were revealed: 1) patient resources and priorities for HIV management; 2) clinical resources and priorities for HIV management; 3) patient resources and priorities for comorbid NCD management; and 4) clinical resources and priorities for comorbid NCD management. |
Simonik et al. [30] (2016), Canada | Descriptive study (semistructured interviews) | To explore readiness to engage in exercise among PLWH with multimorbidity. | Participants: 14 PLWH (HIV and other morbidities); Median age: 50 yrs.; Male: 64.3%; Race: Caucasian 35.7%, Aboriginal/first nation 14.3%, other 21.4%, and not identified 28.6%; Comorbidities: asthma, cancer, eye disorder, hepatitis C, mental health conditions, muscle pain, joint pain, hypertension, peripheral neuropathy, arrhythmia, and neurocognitive decline; Participants were recruited from a specialty hospital in Canada. | Readiness was influenced by 1) physical impairments; 2) mental health challenges; and 3) uncertainty due to HIV and concurrent health conditions. Subfactors that influenced readiness to exercise included 1) social support; 2) perceptions and beliefs; 3) past experience with exercise; and 4) accessibility. |
Slomka et al. [31] (2017), US | Phenomenological study (focus group interviews) | To explore the lived experiences of multimorbidity among PLWH. | Participants: 22 PLWH with at least one other chronic condition; Mean age: 51 yrs.; Male: 73%; Race: Africa American 81.8%; Comorbidities: hypertension, heart disease, heart failure, kidney disease, hepatitis C, liver disease, mental health conditions, diabetes; Participants were recruited from a large specialty HIV clinic in the US. | Four themes were identified: 1) HIV as a background for other chronic conditions; 2) managing medications and provider interactions; 3) coping with future health care needs; and 4) stigmatized social environment of multimorbidity with HIV. |
Warren-Jeanpiere et al. [32] (2014), US | Phenomenological study (focus group interview) | To explore how the age, identity, comorbidities, social responsibilities, and relationship status of older HIV-positive African American women influence their HIV self-management. | Participants: 23 PLWH; Mean age: 57 yrs.; Male: 0%; Race: Africa American 100%; Comorbidities: arthritis, high blood pressure, hepatitis, cancer, depression, heart disease, diabetes; Participants were recruited from one hospital in the US. | Four themes were identified: 1) “Taking it one day at a time”; 2) “Age ain’t nothing but a number”; 3) “Forget the single life”; and 4) “Daily life struggles”. |
Main findings
Findings | Categories | Synthesized Findings |
---|---|---|
Difficulty finding a parking place (U) [22] | Limited access to HIV-related healthcare services | 1. Although the current healthcare systems have many barriers preventing PLWH with NCDs from accessing both HIV and NCD care, they can receive resources and knowledge through healthcare providers. |
Long waiting times at healthcare centers (U) [29] | ||
Mobility restrictions stemming from HIV (U) [30] | ||
Challenges with physical disability (U) [30] | ||
Ability of current healthcare system to meet PLWH needs (U) [31] | ||
Fear of being stigmatized for having HIV (U) [29] | ||
Unavailability of screening machines for hypertension and diabetes (U) [23] | Barriers to accessing healthcare for NCDs | |
Mobility restrictions stemming from other chronic conditions (U) [30] | ||
Unavailability of medication for hypertension (U) [23] | ||
Lack of care continuity (U) [29] | ||
Insufficient care for chronic diseases (U) [29] | ||
Lack of familiarity with the situations of PLWH among healthcare providers from NCD departments (U) [31] | ||
Simultaneous acquisition of knowledge regarding the disease process and social support (U) [17] | Good aspects of the current healthcare systems | |
Utilization of the available resources to avoid isolation and depression (U) [17] | ||
Likely elimination of the stigma attached to the ARV clinic through the provision of integrated care through general systems (U) [29] | ||
Understanding the consequence of nonadherence to treatment (U) [26] | Individual factors affecting care continuity and treatment adherence | 2. The factors that can affect care continuity and treatment adherence for both HIV and NCDs among PLWH include the individual physical, mental, and financial statuses of PLWH; their relationships with clinicians; and fragmented healthcare systems. |
Active engagement in treatment (U) [30] | ||
Substance abuse (U) [26] | ||
Mental issues (U) [26] | ||
Health insurance scheme (C) [27] | ||
Financial issues (U) [27] | ||
Encouragement to continue treatment due to improved symptoms (U) [27] | ||
Fragmented healthcare systems | ||
Distance between the tertiary hospital and HIV clinics (U) [21] | ||
Effect of mistrust of providers on treatment adherence (U) [22] | Patient-clinician partnership | |
Lack of communication (U) [22] | ||
Effect of appearance on self-esteem (U) [17] | Appearance | 3. PLWH with NCDs have long-term physical and psychological manifestations of disease. Psychological manifestations are severe and prevalent when PLWH are informed that they have NCDs. Some changes, including changes in appearance and sexual function, can affect individuals’ daily lives, especially among women living with HIV and NCDs. |
Dental issues (C) [17] | ||
Importance of maintenance physical appearance for women (U) [32] | ||
Fear, anger, and rejection (U) [17] | Psychological manifestations | |
Stress and vulnerability due to the management of multiple conditions (U) [21] | ||
Similarity between reactions to a cancer diagnosis and initial reactions to the HIV diagnosis (U) [22] | ||
Fear of cancer diagnosis and treatments (U) [22] | ||
Mental health treatment (U) [22] | ||
Initial difficulty in accepting the diagnosis of hypertension (U) [24] | ||
Negative emotions upon being informed of having multimorbidities (U) [29] | ||
Effect on women, dyspareunia (U) [17] | Sexual function | |
Effect on one’s life (U) [17] | ||
Extreme fatigue, neuropathy, and memory loss (U) [17] | Physical manifestations | |
Disability (U) [17] | ||
Symptoms disrupting everyday life (U) [27] | ||
Lack of an assumption that any new symptoms are related to HIV (U) [31] | ||
Social consequence of having NCDs | 4. Having more chronic conditions implies more medical costs for PLWH. The more severe the financial hardship of PLWH, the more negatively it affects their employment and family relationships. | |
Effects on relations between family members (U) [18] | ||
Low confidence, even futility (U) [24] | ||
Numerous hospital appointments (U) [18] | ||
Financial and insurance issues | ||
Reliance on a minimal state disability grant (U) [18] | ||
Comparison of free ART with hypertension medication (U) [24] | ||
Lack of income (U) [32] | ||
Fear of rejection before acceptance (U) [17] | Double stigma | 5. PLWH with NCDs experience double stigma toward their HIV and chronic conditions, which may exacerbate their perceived discrimination and lead to social and physical isolation. |
Courtesy stigma (U) [18] | ||
Discrimination leading to social and physical isolation (U) [18] | ||
Personal insecurity within one’s home (U) [18] | ||
Disowning or violent behavior toward the sick person (U) [18] | ||
Stigma among support system and providers (U) [22] | ||
New form of stigma toward cancer (U) [25] | ||
Stigmatized social environment of multimorbidity with HIV (U) [31] | ||
Waiting for as long as possible before sharing one’s diagnosis with family members (U) [17] | Disclosure | |
Openly sharing one’s diagnosis with friends but ultimately losing them (U) [17] | ||
Pill burden for managing both conditions (U) [24] | Pill burden | 6. PLWH with NCDs have high levels of polypharmacy burden for both ART and other medications. This population has difficulty maintaining high medication adherence due to medication fatigue, side effects, and the large numbers of pills to be taken. PLWH with NCDs may spontaneously use some strategies individually or collectively to achieve high levels of medication adherence. |
Taking pills daily as a form of survivorship (U) [17] | Polypharmacy adherence | |
Taking multiple drugs as compensation for missed doses (U) [23] | ||
Side effects of hypertension medication as an impediment to adherence (C) [24] | ||
Simpler regimens with fewer side effects promoting adherence (U) [26] | ||
Medication fatigue (U) [32] | ||
Difficulty keeping up with the management regimens for their other comorbidities (U) [32] | ||
Side effects | ||
Side effects of medication interaction (U) [31] | ||
Perception of taking pills | ||
Shared cautionary stories of friends impacted by hypertension as sources of motivation (U) [24] | ||
Perceived symptoms as cues to take medication (U) [28] | ||
Borrowing NCD medication from colleagues (U) [23] | Coping strategies for maintaining high polypharmacy adherence | |
Using home remedies (U) [23] | ||
Using traditional herbs (U) [23] | ||
Consulting traditional or faith healers (U) [24] | ||
Taking both types of medications simultaneously (C) [24] | ||
Establishing daily reminders (C) [24] | ||
Involving family members in care (C) [24] | ||
Having a shared ‘drug bag’ (C) [24] | ||
View of hypertension as more deadly than HIV (U) [24] | Comparison of the experience of having HIV with having NCDs | 7. Some PLWH with NCDs consider hypertension and cancer more concerning conditions than HIV. However, they still describe the ability of HIV to hibernate. Having NCDs may mask concerns regarding HIV and HIV-positive experiences, which can reinforce the self-management of NCDs. |
Transmission (U) [24] | ||
Perception of hypertension as more severe than HIV (U) [24] | ||
View cancer as a totally different type of disease (U) [25] | ||
Difference in the survival rates of HIV and cancer (U) [25] | ||
Identification of cancer as the most concerning condition (U) [25] | ||
Concerns regarding NCDs that mask concerns regarding HIV (U) [25] | ||
View of having NCDs with HIV as the same as having NCDs without HIV (U) [31] | ||
Describing HIV as in hibernation (U) [31] | ||
View ART resistance as the most feared consequence (U) [24] | Comparison of ARTs with other NCD medication | |
Belief that medications for hypertension give PLWH energy (U) [24] | ||
Belief that medications are necessary for HIV but not for hypertension (U) [24] | ||
View the effectiveness of ART and antihypertensive medications (U) [24] | ||
Conflicting treatment and information | ||
Reinforcement of self-efficacy for one disease by self-efficacy for another disease (U) [24] | Reinforcement of the self-management of other diseases by HIV | |
Encouraging someone else to adhere to treatment based on one’s own experience of ART (U) [24] | ||
Acceptance of the hypertension diagnosis (U) [29] | ||
Rethinking of the definition of self-management (U) [32] | ||
Readiness to engage but awareness of limitations due to HIV and NCDs (U) [30] | Exercising | 8. While facing HIV with NCDs, PLWH can develop positive coping strategies to accept the realities of living with multiple chronic conditions. |
Physical impairments (U) [30] | ||
Mental health challenges (U) [30] | ||
Uncertainty (U) [30] | ||
Social support (C) [30] | ||
Perceptions and beliefs (U) [30] | ||
Feeling of accomplishment (U) [30] | ||
Seeking family support | ||
Love burden (U) [24] | ||
Familial support (U) [17] | ||
Eagerness to share with their friends and/or loved ones for support (U) [17] | ||
Companionship received from male partners as an inspiration to self-manage HIV and comorbidities (U) [24] | ||
Simultaneous acquisition of knowledge regarding the disease process and social support (U) [17] | Changing life goals | |
Utilization of the available resources to avoid isolation and depression (U) [17] | ||
Likely elimination of the stigma attached to the ARV clinic through the provision of integrated care through general systems (U) [29] | ||
Frustration with being told by healthcare providers to change lifestyle habits (U) [24] | Making lifestyle adjustments | |
Initial period of adjustment with beginning a new medication regimen and new lifestyle changes (U) [24] | ||
CVD prevention knowledge inconsistent with PLWH CVD risk behavior (U) [28] | ||
Motivation for adopting healthy behaviors | ||
Lack of motivation or interest in exercise (U) [30] | ||
Readiness to engage in exercise as a dynamic construct (U) [30] | Readiness to engage in exercise | |
Feeling of readiness to engage in exercise amidst unique circumstances (U) [30] | ||
Resilience (U) [22] | Developing resilience | |
Struggles with tolerating treatment (U) [17] | Developing a self-capacity to manage HIV and comorbidities | |
Initiation of learning about the virus from the moment of accepting the diagnosis (U) [17] | ||
Initiation of learning to be an example for others (U) [17] | ||
Discordance between providers’ recommendations and the preferred strategy for CVD prevention among PLWH (U) [28] | ||
Increased ability and desire to self-manage one’s health with age (U) [32] | ||
Spirituality (U) [27] | Addressing spiritual needs | |
Addressing spiritual needs (U) [31] | ||
From a state of ownership to one of self-advocacy (U) [17] | Increasing subjective initiative | |
Self-advocacy for one’s overall health (U) [17] | ||
Frustration and struggles with new day-to-day routines (U) [17] | Daily struggles | 9. Some PLWH living with chronic diseases struggle with new daily routines, emotional difficulties, and family issues. In extreme cases, PLWH may have suicidal ideation when experiencing high pressure. |
Existing rather than living (U) [17] | ||
Emotional and mental health difficulties (U) [22] | ||
Daily family or personal issues (U) [22] | ||
Profound psychological effects of physical and social dislocation from the family home on PLWH (U) [18] | Suicide | |
Combination of socioeconomic factors, political factors, and chronic illnesses (U) [21] | ||
Suicidal ideation (U) [25] |
Synthesized finding 1
Although barriers were identified, some participants were still satisfied with their providers [17, 22] and the current HIV-related healthcare services in terms of the simultaneous acquisition of knowledge about the disease process and social support [17]. PLWH could utilize available resources to avoid isolation and depression under the current systems [17]. Receiving integrated HIV/NCD care through general systems was likely to remove PLWH’ stigma attached to the antiretroviral therapy clinic [29].“As for me, my blood pressure (BP) was only checked once this year. Most of the time I come here, there will be no electricity, so the BP machine will not be working. Sometimes you come here, and you are told the machine is being used in the maternity ward.” (A participant from South Africa) [23]
“They do a lot of tea time; they’ll have workshops on living well with HIV, how to make out your will, how to live on a budget, healthier exercise, healthy eating. So, that’s really good.” (A participant from the United States) [17]
Synthesized finding 2
Among all factors, fragmented and uncoordinated HIV care and chronic care [21, 22, 29, 31] and HIV being beyond generalists’ scope of practice [17, 22, 29] were the most commonly mentioned reasons for why PLWH do not continuously seek healthcare for NCDs.“[When] I was getting high smoking crack and using drugs, I really didn’t care whether I was HIV-positive and high blood pressure or anything.” (A participant from the United States) [26]
“I attend four clinics [ … ]. Today, I am here; then, next month, I’ll attend two other clinics.” [4]
“I always get my ARVs from Ntabiseng clinic in Bara and my diabetes pills from the diabetes clinic.” (A participant from South Africa) [21]
Synthesized finding 3
PLWH with NCDs also reported changes in appearance and sexual function [17, 27, 31]. Women with PLWH and NCDs suffer severe long-term manifestations, including oral health issues, changes in physical appearance, decreased self-esteem, and dyspareunia [17, 32].“No one wants to hear that word cancer, that you have it. Now you have this diagnosis, and the first thing you think is okay, death is next. Life is almost over.” (A participant from the United States) [22]
“One of the side effects is that you have light atrophy where the muscle patch in your face disappears, and so suddenly, you're walking around looking like a human skeleton. You look in the mirror and … and I don’t think anyone’s really fond of looking in the mirror at all, just even to comb your hair, brush your teeth. It’s like a passing glance because it just makes you too depressed to see the physicality that’s happened.” (A participant from the United States) [17]
Synthesized finding 4
From a long-term perspective, having NCDs directly increased the number of hospital appointments [18] and indirectly affected their employment [17, 18], family relationships [18], and confidence [24]. The more severe the financial hardship of PLWH, the more negatively it affected their employment and family relationships.“Taking [hypertension] medicine is not a choice but a problem where I cannot find the medicine, while the ART, I have never been in a situation that I want to go get the drugs but find that there is no medicine at the hospital … all times, they are there and are free” (A participant from Malawi) [24]
“Sometimes it happens that you don’t have money to buy the drugs … with time, if you haven’t done any work and the drugs are almost finished, you don’t know what to do.” (A participant from Malawi) [24]
Synthesized finding 5
“They’re trying to make HIV like cancer or anything else. I mean we all kind of wanted that kind of acceptance, but it’s still not as common as cancer or lupus or anything. You know it still has its stigma to it.” (A participant from the United States) [31].“They hid HIV before. But now, they talk about it. Now, they hide cancer. People, they are very negative about cancer.” (A participant from South Africa) [25]
Synthesized finding 6
PLWH with NCDs may spontaneously use some strategies individually or collectively to achieve high levels of medication adherence, such as borrowing NCD medication from colleagues [23], consulting traditional or faith healers [24], taking both HIV and NCD medications simultaneously [24], establishing daily reminders [24], involving family members in care [24], and using a shared “drug bag” [24]. To decrease the financial burden, some PLWH used less expensive NCD remedies (including home remedies and traditional herbs) or resorted to faith and traditional healers instead of using prescribed allopathic medicines. Therefore, they were able to maintain a high level of therapeutic compliance and medication adherence with traditional therapy and remedies [23].“One time, I had stopped taking my medicine for a whole month, you know. I’m tired of taking medicine.” (A participant from the United States) [32]
“I know that [prescribed] drugs are effective … but one needs money to buy them. Prophets, traditional healers … and home remedies are cheaper or even free, … so, I can’t watch myself die when these options are there.” (A participant from South Africa) [23]
Synthesized finding 7
PLWH with NCDs compared ART with NCDs treatment. One study from Malawi showed that PLWH considered ART resistance to be the most fearful outcome [24]. Some participants believed that medication for hypertension gave them energy, but other participants believed that medications were necessary for HIV but not for hypertension [24]. Three studies described conflicting treatments and information between their HIV and NCD care [21, 25, 26].“I got the HIV, I ain’t going to worry about that. I have to worry about having a heart attack or a stroke.” (A participant from the United States) [26]
Four studies reported that HIV can reinforce the self-management of other NCDs [24, 28, 29, 32]. Long-term HIV care experience had a positive impact on the acceptance of NCD diagnosis and NCD medication adherence [24, 28, 29]. PLWH with NCDs also encouraged others to adhere to treatment based on their experience with ART [24].“Chemo really almost killed me. It was the cause of my white blood cells dying, [the doctors] told me that my CD4 cells are down.” (A participant from the United States) [26]
Synthesized finding 8
“[Medication] helps my heart; I wanna keep that heart going. I don’t want any heart disease—I don’t have a history of it—but I don’t want to...I have high risk factors, and I try to take care of that with diet, and exercise, and medicine. So, you only get one heart, and it’s okay.” (A participant from the United States) [28]
Synthesized finding 9
"My sister had an aneurysm and just drops dead. Then, I said, I can’t do [the cancer treatments] anymore. I’m hurting and I couldn’t, I just said, no, I’m not doing it no more. I stopped everything and I gave up." (A participant from the United States) [22]
ConQual summary of the synthesized findings
Synthesized Findings | Type of Research | Dependability | Credibility | ConQual Score |
---|---|---|---|---|
1. Although the current healthcare systems have many barriers preventing PLWH with NCDs from accessing both HIV and NCD care, they can receive resources and knowledge through healthcare providers. | Qualitative | Downgrade 1 level | – | Medium |
2. The factors that can affect care continuity and treatment adherence for both HIV and NCDs among PLWH include the individual physical, mental, and financial statuses of PLWH; their relationships with clinicians; and fragmented healthcare systems. | Qualitative | Downgrade 1 level | Downgrade 1 level | Low |
3. PLWH with NCDs have long-term physical and psychological manifestations of disease. Psychological manifestations are severe and prevalent when PLWH are informed that they have NCDs. Some changes, including changes in appearance and sexual function, can affect individuals’ daily lives, especially among women living with HIV and NCDs. | Qualitative | Downgrade 1 level | Downgrade 1 level | Low |
4. Having more chronic conditions implies more medical costs for PLWH. The more severe the financial hardship of PLWH, the more negatively it affects their employment and family relationships. | Qualitative | Downgrade 1 level | – | Medium |
5. PLWH with NCDs experience double stigma toward their HIV and chronic conditions, which may exacerbate their perceived discrimination and lead to social and physical isolation. | Qualitative | Downgrade 1 level | – | Medium |
6. PLWH with NCDs have high levels of polypharmacy burden for both ART and other medications. This population has difficulty maintaining high medication adherence due to medication fatigue, side effects, and the large numbers of pills to be taken. PLWH with NCDs may spontaneously use some strategies individually or collectively to achieve high levels of medication adherence. | Qualitative | Downgrade 1 level | Downgrade 1 level | Low |
7. Some PLWH with NCDs consider hypertension and cancer more concerning conditions than HIV. However, they still describe the ability of HIV to hibernate. Having NCDs may mask concerns regarding HIV and HIV-positive experiences, which can reinforce the self-management of NCDs. | Qualitative | Downgrade 1 level | – | Medium |
8. While facing HIV with NCDs, PLWH can develop positive coping strategies to accept the realities of living with multiple chronic conditions. | Qualitative | Downgrade 1 level | Downgrade 1 level | Low |
9. Some PLWH living with chronic diseases struggle with new daily routines, emotional difficulties, and family issues. In extreme cases, PLWH may have suicidal ideation when experiencing high pressure. | Qualitative | Downgrade 1 level | – | Medium |