Kiplagat Jepchirchir, Naanyu Violet, Kamano Jemimah, Vedanthan Rajesh, Pastakia Sonak, Wools-Kaloustian Kara
Academic Model Providing Access to Healthcare, Eldoret, Kenya.
Moi University, School of Public Health, Department of Epidemiology and Medical Statistics, Eldoret, Kenya.
BMC Geriatr. 2025 Aug 7;25(1):599. doi: 10.1186/s12877-025-06288-8.
Advances in antiretroviral therapy have enabled people living with HIV (PLHIV) to live longer and healthier lives. However, aging with HIV infection is accompanied by an increased risk of non-communicable diseases (NCDs), highlighting the need to integrate care services. The Academic Model Providing Access to Healthcare (AMPATH) in Eldoret, Kenyahas, which has been providing care for PLHIV for over 30 years, is seeing an increase in NCDs, particularly hypertension and diabetes, especially among older patients. It is unclear how healthcare providers manage the complex healthcare needs of older adults living with HIV (OALWH) and comorbid NCDs, or how they perceive the integration of hypertension and diabetes care within the HIV care platform.
We conducted in-depth interviews at an AMPATH facility in Eldoret, Kenya. Ten healthcare providers (three nurses and seven clinical officers) were interviewed to explore the facilitators and barriers to integrating HIV and NCD care services for OALWH. Audio records were transcribed verbatim, content analysis was performed, and the capabilities (C), opportunities (O), and motivation (M) models for behavior change (COM-B model) were used to comprehensively map the drivers and barriers that shape healthcare providers' acceptance, adoption, and implementation of integrated HIV and NCD care services.
The majority of participants had worked for more than five years, offering care for people living with HIV. All participants had experience managing older adults living with HIV and expressed challenges with the lack of coordinated care delivery for HIV and NCDs. The participants highlighted the potential challenges of optimal adherence to antiretroviral therapy (ART) among OALWH in the presence of multiple chronic conditions. Based on these challenges, participants perceived the integration of hypertension and diabetes care into the HIV care platform as beneficial to clients and the overall healthcare system. Factors such as the availability of physical resources and infrastructure (C), availability of training opportunities for NCD care (O), leadership support (M), and motivation to provide person-centered care (M) were perceived as facilitators of HIV/NCD integrated care delivery. Impeding factors such as lack of guidelines for integration (O), siloed healthcare service delivery (O), inadequate resource allocation for NCDs (O), and perceived increased workload (M) were also highlighted by healthcare providers.
The findings of this study highlight healthcare providers' perceived facilitators and barriers to the integration of NCD care into HIV care platforms. The insights gained from this study hold the potential to inform tailored interventions, policy decisions, and capacity-building initiatives aimed at fostering successful integration and improving overall health care delivery to meet the needs of OALWH in resource-constrained settings.
抗逆转录病毒疗法的进展使艾滋病毒感染者（PLHIV）能够更长寿、更健康地生活。然而，随着年龄增长，感染艾滋病毒会增加患非传染性疾病（NCDs）的风险，这凸显了整合护理服务的必要性。肯尼亚埃尔多雷特的学术医疗服务获取模式（AMPATH）为PLHIV提供护理服务已有30多年，目前非传染性疾病的发病率在上升，尤其是高血压和糖尿病，在老年患者中尤为明显。尚不清楚医疗服务提供者如何管理感染艾滋病毒的老年人（OALWH）以及合并非传染性疾病患者的复杂医疗需求，或者他们如何看待在艾滋病毒护理平台内整合高血压和糖尿病护理。
我们在肯尼亚埃尔多雷特的一个AMPATH机构进行了深入访谈。采访了10名医疗服务提供者（3名护士和7名临床干事），以探讨为感染艾滋病毒的老年人整合艾滋病毒和非传染性疾病护理服务的促进因素和障碍。对音频记录进行逐字转录，进行内容分析，并使用行为改变的能力（C）、机会（O）和动机（M）模型（COM-B模型）全面梳理影响医疗服务提供者接受、采用和实施艾滋病毒与非传染性疾病综合护理服务的驱动因素和障碍。
大多数参与者工作年限超过五年，为艾滋病毒感染者提供护理。所有参与者都有管理感染艾滋病毒的老年人的经验，并表示在艾滋病毒和非传染性疾病护理服务缺乏协调方面存在挑战。参与者强调了在存在多种慢性病的情况下，感染艾滋病毒的老年人最佳坚持抗逆转录病毒疗法（ART）的潜在挑战。基于这些挑战，参与者认为将高血压和糖尿病护理纳入艾滋病毒护理平台对患者和整个医疗系统都有益。诸如物质资源和基础设施的可用性（C）、非传染性疾病护理培训机会的可用性（O）、领导支持（M）以及提供以患者为中心护理的动机（M）等因素被视为艾滋病毒/非传染性疾病综合护理服务的促进因素。医疗服务提供者还强调了一些阻碍因素，如缺乏整合指南（O）、医疗服务提供分散（O）、非传染性疾病资源分配不足（O）以及工作量增加的感觉（M）。
本研究结果突出了医疗服务提供者对将非传染性疾病护理纳入艾滋病毒护理平台的促进因素和障碍的认知。从本研究中获得的见解有可能为量身定制的干预措施、政策决策和能力建设举措提供信息，旨在促进成功整合并改善整体医疗服务，以满足资源有限环境下感染艾滋病毒的老年人的需求。
