Barriers and facilitators to integration of screening for hypertension, diabetes mellitus and dyslipidaemia, among adult people living with HIV at district hospital ART clinics in Southern Malawi.

BACKGROUND

Atherosclerotic cardiovascular diseases (ASCDs) are a significant health concern globally and in Sub-Saharan Africa (SSA), particularly for people living with HIV (PLWH). Hypertension, diabetes mellitus (DM), and dyslipidaemia significantly increase the risk of ASCDs, and integrating screening for these conditions in public health facilities remains challenging in Malawi. This study aimed to explore the barriers and facilitators to integrating screening for hypertension, DM and dyslipidaemia among adult PLWH at district hospital ART clinics in Southern Malawi.

METHODS

This was mixed-methods study conducted between November 2021 and April 2022. Quantitative data was collected from retrospective ART clinic records from between 2016 and 2020 (n = 875) from five district hospital ART clinics and informed the subsequent qualitative data collection, guided by the Consolidated Framework for Implementation Research (CFIR) in three purposively selected district hospital ART clinics. The qualitative aspect included in-depth interviews, focus group discussions, and key informant interviews. Non-participant observations were also conducted to assess the availability of functional screening equipment. Descriptive statistics were used to analyse the quantitative data while the qualitative data was analysed using thematic analysis.

RESULTS

One district hospital ART clinic facility only performed the screening for hypertension and DM (40% and 9.84% at the commencement of ART and 39.4% and 5.14% in 2021). Facilitators for integration included time efficiency, patient information integration, existing infrastructure utilization, organisational incentives and training. Barriers included clinic ow delays, additional strain on a limited workforce, lack of prioritization and resources, increased workload and inadequate knowledge. PLWH expressed fear of screening and diagnosis without available medication.

CONCLUSION

The study found poor integration of hypertension, DM and dyslipidaemia screening among PLWH in Southern Malawi, but highlighted opportunities for successful implementation. Our study emphasizes the feasibility of the intervention and the importance of coordination between HIV and NCD care services in low-income settings such as Malawi.