Badacho Abebe Sorsa, Woltamo Deginesh Dawit, Demissie Dereje Bayissa, Mahomed Ozayr Haroon
School of Nursing and Public Health, Public Health Medicine Discipline, University of KwaZulu-Natal, Durban, South Africa.
School Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
SAGE Open Med. 2024 May 22;12:20503121241253960. doi: 10.1177/20503121241253960. eCollection 2024.
To map the evidence on the barriers to and facilitators of diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries in Africa.
Noncommunicable diseases are increasing among people living with HIV. Thus, strengthened and sustained diagnosis of noncommunicable diseases through integrated noncommunicable diseases and HIV care is needed to improve patient outcomes. However, there is paucity of evidence on the barriers and facilitators diagnosing noncommunicable diseases among people living with HIV in low- and middle-income countries.
The Arksey and O'Malley methodological framework was used. A comprehensive systematic search of academic databases (MEDLINE, Academic Search Complete, APA PsycInfo, CAB, and Health Source/Nursing) was performed via EBSCO search and PubMed. The articles were reviewed independently by three reviewers. The results were structured using Capability-Opportunity-Motivation-Behavior model and Theoretical Domains Framework.
A total of 152 articles were retrieved for full-text review. Forty-one articles met the inclusion criteria. The identified barriers were relevant to all the Capability-Opportunity-Motivation-Behavior constructs and 14 Theoretical Domains Framework domains. A lack of knowledge and awareness of noncommunicable diseases, fear of stigma, financial problems and out-of-pocket payments were the most cited patient-level barriers. Healthcare providers (knowledge and awareness gaps, skill and competence deficiencies, unwillingness, burnout, low motivation, and apathy) were frequently cited. Lack of equipment, noncommunicable disease medications and supply chain challenges, lack of integrated noncommunicable disease and HIV care, and shortage of trained healthcare providers were identified as health-system-level barriers.
This scoping review is the first to identify barriers and facilitators using a theoretical framework. The most cited barriers include a lack of integrated HIV and noncommunicable disease care, equipment and logistics chain challenges for noncommunicable diseases, patients' and healthcare providers' lack of knowledge and awareness of noncommunicable diseases, and healthcare provider's skill and competency deficiencies. Addressing these issues is crucial for improving patient outcomes and reducing the burden on healthcare providers and health systems.
梳理非洲低收入和中等收入国家艾滋病毒感染者中，非传染性疾病诊断的障碍因素与促进因素方面的证据。
艾滋病毒感染者中非传染性疾病的发病率正在上升。因此，需要通过整合非传染性疾病和艾滋病毒护理，加强并持续开展非传染性疾病的诊断工作，以改善患者的治疗效果。然而，关于低收入和中等收入国家艾滋病毒感染者中非传染性疾病诊断的障碍因素与促进因素，相关证据匮乏。
采用阿克西和奥马利的方法框架。通过EBSCO搜索和PubMed，对学术数据库（MEDLINE、学术搜索完整版、美国心理学会心理学文摘数据库、CAB和健康源/护理）进行全面系统的检索。由三位评审员独立审阅文章。结果采用能力-机会-动机-行为模型和理论领域框架进行梳理。
共检索到152篇文章进行全文审阅。41篇文章符合纳入标准。确定的障碍因素与能力-机会-动机-行为模型的所有构成要素以及14个理论领域框架领域相关。患者层面最常被提及的障碍包括对非传染性疾病缺乏了解和认识、害怕耻辱感、经济问题和自付费用。医疗服务提供者（知识和认识差距、技能和能力不足、不愿意、倦怠、积极性低和冷漠）也经常被提及。设备、非传染性疾病药物和供应链方面的挑战、缺乏非传染性疾病和艾滋病毒综合护理以及训练有素的医疗服务提供者短缺被确定为卫生系统层面的障碍。
本范围综述首次使用理论框架确定障碍因素与促进因素。最常被提及的障碍包括缺乏艾滋病毒和非传染性疾病综合护理、非传染性疾病的设备和物流链挑战、患者和医疗服务提供者对非传染性疾病缺乏知识和认识以及医疗服务提供者的技能和能力不足。解决这些问题对于改善患者治疗效果、减轻医疗服务提供者和卫生系统的负担至关重要。
