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Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda: a qualitative exploration of experiences accessing an integrated care service

Marie Claire Annette Van Hout (Faculty of Health, Liverpool John Moores University, Liverpool, UK)
Flavia Zalwango (MRC∕UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda)
Mathias Akugizibwe (MRC∕UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda)
Moreen Namulundu Chaka (MRC∕UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda)
Charlotte Bigland (Faculty of Health, Liverpool John Moores University, Liverpool, UK)
Josephine Birungi (MRC∕UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda)
Shabbar Jaffar (Liverpool School of Tropical Medicine, Liverpool, UK)
Max Bachmann (Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK)
Jamie Murdoch (King's College London, London, UK)

Journal of Integrated Care

ISSN: 1476-9018

Article publication date: 2 December 2022

Issue publication date: 7 February 2023

31

Abstract

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.

Keywords

Acknowledgements

The authors would like to sincerely thank all participants in the INTE-AFRICA trail in Uganda.

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.

Citation

Van Hout, M.C.A., Zalwango, F., Akugizibwe, M., Namulundu Chaka, M., Bigland, C., Birungi, J., Jaffar, S., Bachmann, M. and Murdoch, J. (2023), "Women living with HIV, diabetes and/or hypertension multi-morbidity in Uganda: a qualitative exploration of experiences accessing an integrated care service", Journal of Integrated Care, Vol. 31 No. 1, pp. 86-99. https://doi.org/10.1108/JICA-06-2022-0033

Publisher

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Emerald Publishing Limited

Copyright © 2022, Emerald Publishing Limited

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