Care and management of a double burden of chronic diseases: Experiences of patients and perceptions of their healthcare providers

Abstract

The increasing burden of comorbid HIV infection and hypertension necessitates a focus on healthcare services providing care for chronic multi-morbidities. The aim of this study was to evaluate the perceptions and experiences of 1) people living with HIV infection and comorbid hypertension, and 2) their healthcare providers, related to their diagnoses and interactions with chronic healthcare services in South Africa. Methods This study comprised quantitative and qualitative arms with a multi-layered approach. We randomly selected 17 public healthcare facilities providing HIV care across Cape Town and surrounding rural municipalities. Results Interviews were conducted with clinicians (n = 11), specialised nursing professionals (n = 10), lay counsellors (n = 12), six patients focus groups (n = 35) and 20 in-depth individual patient interviews. There were mixed views on being treated at integrated vs. separate chronic care facilities regarding quality of care and privacy/anonymity. Specialised clinics offered better care for HIV infection while hypertension and other non-communicable diseases were neglected. Privacy about HIV status maybe better maintained in integrated clinics but not if status was disclosed by having the green-coloured HIV treatment card. A single appointment date was considered advantageous as it saved time and money leading to greater compliance; however, waiting times at clinics were longer with perhaps fewer patients seen. Conclusions The mixed reactions elicited to the integration of healthcare services for HIV, hypertension and other non-communicable diseases highlights the complexities involved in implementing

Patient perspectives on integrated healthcare for HIV, hypertension and type 2 diabetes: a scoping review

“…Full texts were retrieved for 20 articles. Of these, 13 were eligible 10 14 21–31 for inclusion, 7 were excluded during the assessment of full texts ( figure 1 ).…”

“…All included publications were original research articles, used cross-sectional study designs, and were published between 2016 and 2021. All were qualitative studies, and all except two 14 29 used semistructured interviews, 27 in-depth interviews 10 22 24 30 31 or a combination of these 21 26 28 ( table 3 ). Some studies combined the interviews with instruments such as focus group discussions and patient observations.…”

“…25 In Cape Town, South Africa, PLWH and comorbid HT experienced a lack of continuity of care (different healthcare workers) but were generally glad for the more holistic treatment approach in the integrated healthcare clinics. 10 Waiting times at the facilities Long queues and waiting times prior to appointments at the facilities were experienced by patients in Langa and Khayelitsha, especially pronounced prior to clinical appointments for T2D. In the context of HIV services this was not a problem, where advancements have been made through MACs, which avoided overcrowding and reduced waiting times at the health facilities.…”

“…14 25 PLWH with comorbid HT in Cape Town also had concerns related to longer waiting times in integrated healthcare facilities. 10 Bosire 24 Fragmented care ► Travel costs leading to patients' defaulted appointments leading to poor patientprovider relationship. ► Poor interprovider communication leading to incoherent treatment.…”

“…14 In Cape Town, South Africa, PLWH experienced reduced stigma when attending integrated healthcare, instead of ART clinics. 10 In Kenya, the integrated MACs were found to reduce HIV-related stigma as some MAC members experienced HIV being treated like 'any other chronic disease'. While the overall perception was that the MACs reduced the stigma related to HIV, some PLWH that were not using MACs, thought they had to disclose their HIV status to join the clubs, thus fearing of being stigmatised, if someone from their community recognised them.…”