Abstract:
Background 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.
Methods 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.
Results 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.
