AI Insight
This systematic review of 13 qualitative studies from six African countries examined how 458 people living with HIV manage concurrent hypertension or diabetes in low- and middle-income countries. The research identified five key self-care themes including understanding illnesses and medications, adopting different treatment approaches for HIV versus other conditions, implementing lifestyle changes, managing psychological distress, and navigating healthcare system gaps. Patients faced significant treatment burdens due to disparities in care quality between HIV services and hypertension/diabetes services, requiring them to compensate for inadequate support in managing their non-HIV conditions.
Why it matters
As HIV becomes a manageable chronic condition, people living with HIV increasingly face hypertension and diabetes, requiring coordinated self-care across multiple conditions. The findings reveal critical gaps in integrated care delivery in resource-limited settings and highlight the need for consistent patient education, psychosocial support, and healthcare models that reduce the cumulative burden on patients managing multiple chronic diseases simultaneously.
Understand the Science
by Andrew K. Tusubira, Andrew S. Ssemata, Anne R. Katahoire, Carl May, Christine K. Nalwadda, Moffat Nyirenda, Susannah Mayhew
Background
People living with HIV in low-and middle-income countries (LMICs) face a growing burden of hypertension and diabetes comorbidities. Although self-care is essential, limited evidence exists on how patients manage these conditions concurrently within resource-constrained settings. We examined self-care practices among people living with HIV and hypertension or diabetes comorbidities in LMICs and identified treatment burdens related to these practices.
Methods
We searched Medline, EMBASE, PsycINFO, Global Health, Scopus, Web of Science, CINAHL, WHO Global Index Medicus, African Journals Online and, Google Scholar for primary studies conducted in LMICs and published between January 2013 and March 2026, regardless of study design and data collection method. Two reviewers independently screened, extracted data, and assessed study quality, resolving discrepancies through discussions. We used thematic synthesis to analyze self-care practices, and mapped findings onto the Normalization Process Theory to identify associated treatment burdens. Confidence in the evidence was assessed using the GRADE-CERQual approach.
Results
Thirteen qualitative studies from six African countries, comprising 458 participants, were included. Seven studies were rated high quality while six were moderate. Five themes emerged with moderate-to-high confidence in evidence: 1) Sense-making of illnesses and medications; 2) Divergent treatment approaches between HIV and hypertension or diabetes treatment; 3) Adoption of health-promoting behaviors, including lifestyle changes; 4) Coping with psychosocial distress, and 5) Strategies to navigate healthcare insecurities. Related treatment burdens were linked to prescribed healthcare tasks, disparities between HIV and hypertension/diabetes care, and patient-initiated efforts to compensate for gaps in hypertension/diabetes care.
Conclusion
Self-care practices were diverse and shaped by individuals’ interpretations of illnesses, structural inequities, and the cumulative demands of multimorbidity. Strengthening consistent education on illness and medications, psychosocial support, and lifestyle guidance can improve equitable integrated care and support effective self-care. Future research should quantify self-care workload and treatment burden and evaluate integrated care models that reduce patient workload.
Systematic review registration
PROSPERO: CRD42023463738.