Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Sci Rep. 2024 Nov 21;14(1):28862. doi: 10.1038/s41598-024-79967-y.
In patients with HIV-diabetes mellitus (DM) comorbidity, invasive blood glucose testing can increase the risk of HIV-related blood contamination and discourage regular glucose monitoring. Digital continuous glucose monitoring (CGM) systems may allow real-time glucose monitoring without the need for blood specimens. However, in high-burden HIV-DM countries, current glucose monitoring practices and their challenges are insufficiently explored to guide digital CGM research and developments. This study sought to explore the lived experiences of patients with HIV-DM comorbidity and their healthcare providers regarding glucose monitoring practices, and their openness to CGM and other digital technologies, to provide formative insights for a planned implementation trial of digital CGM in Ethiopia. A phenomenological qualitative study was conducted among patients with HIV-DM and their providers at the two largest public hospitals in Ethiopia. Both groups were interviewed face-to-face about DM clinic workflows, blood glucose monitoring and self-testing practices, and potential benefits and limitations of digital CGM systems. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. A total of 37 participants were interviewed, consisting of 18 patients with HIV-DM comorbidity and 19 healthcare providers. Patients had an average (min-max) duration of living with HIV and DM of 14 (8-31) and 6.6 (1-16) years, respectively, with 61% taking insulin-33% alone and 28% alongside oral hypoglycemic agents-and 79% having comorbid hypertension. The thematic analysis identified five main themes: "Diabetes routine clinical care and follow-up", "Blood glucose monitoring practices", "Perceptions about digital CGMs", "Technology adoption", and "Financial coverage". Home self-testing was deemed beneficial, but the need for regular follow-ups, result cross-referencing, and glucometer reliability were emphasized. Patients performed fingerstick themselves or with family members, expressing concerns about waste disposal and the risk of HIV transmission. They rely mainly on health insurance for DM care. Patients and providers are happy with the quality of DM services but note a lack of integrated HIV-DM care. Very few providers and patients possessed background information about digital CGMs, and all have not yet utilized them in practice, but expressed keen interest in trying them, representing an important step for upcoming CGM clinical trials in these settings. Given the crucial role of regular glucose testing in managing HIV-DM comorbidity, it is essential to explore testing options that align with patient preferences and minimize the risk of HIV transmission.
在 HIV 合并糖尿病（DM）的患者中，侵入性血糖检测会增加与 HIV 相关的血液污染风险，并阻碍常规血糖监测。数字连续血糖监测（CGM）系统可以实时监测血糖，而无需采集血样。然而，在高负担 HIV-DM 国家，目前的血糖监测实践及其面临的挑战尚未得到充分探索，无法为数字 CGM 的研究和开发提供指导。本研究旨在探索 HIV-DM 合并症患者及其医疗保健提供者在血糖监测实践方面的真实体验，以及他们对 CGM 和其他数字技术的接受程度，以为计划在埃塞俄比亚开展的数字 CGM 实施试验提供形成性见解。在埃塞俄比亚的两家最大公立医院，对 HIV-DM 患者及其提供者进行了一项现象学定性研究。两组人员均接受了有关 DM 诊所工作流程、血糖监测和自我检测实践以及数字 CGM 系统潜在益处和局限性的面对面访谈。访谈内容被录音、逐字转录，并进行了主题分析。共有 37 名参与者接受了访谈，包括 18 名 HIV-DM 合并症患者和 19 名医疗保健提供者。患者 HIV 感染和 DM 的平均（最小-最大）持续时间分别为 14 年（8-31 年）和 6.6 年（1-16 年），其中 61%接受胰岛素治疗-33%单独使用，28%联合使用口服降糖药-79%合并高血压。主题分析确定了五个主要主题：“糖尿病常规临床护理和随访”、“血糖监测实践”、“对数字 CGM 的看法”、“技术采用”和“财务覆盖范围”。家庭自我检测被认为是有益的，但需要定期随访、结果交叉参考和血糖仪的可靠性。患者自己或与家人进行指尖采血，对废物处理和 HIV 传播风险表示担忧。他们主要依靠医疗保险来支付 DM 护理费用。患者和提供者对 DM 服务的质量感到满意，但注意到缺乏 HIV-DM 综合护理。很少有提供者和患者具备数字 CGM 的背景信息，并且所有人都尚未在实践中使用过，但表示有兴趣尝试，这代表着即将在这些环境中开展 CGM 临床试验的重要一步。鉴于定期血糖检测在管理 HIV-DM 合并症方面的关键作用，探索符合患者偏好并最大程度降低 HIV 传播风险的检测选项至关重要。
