Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2024 Dec 9:rs.3.rs-5373585.
doi: 10.21203/rs.3.rs-5373585/v1.

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

Kondwani G H Katundu  1 , Victoria Mukhula  2 , Zaithwa Matemvu  3 , Angel J Mtonga  1 , Myness Kasanda-Ndambo  1 , Adriano F Lubanga  1 , Monalisa G Malenje  4 , Wongani Nyangulu  1 , Grace Momba  5 , Isotta Triulzi  6 , Noel Kalanga  1 , Mwapatsa Mipando  1 , Alinane Linda Nyondo-Mipando  1 , Mina C Hosseinipour  7
Affiliations

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

Kondwani G H Katundu et al. Res Sq. .

Abstract

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.

Keywords: Atherosclerotic cardiovascular diseases; DM mellitus; Integration; Malawi; Sub-Saharan Africa; dyslipidaemia; hypertension; implementation strategies; people living with HIV.

PubMed Disclaimer

Conflict of interest statement

Competing interests The authors declare no competing interests. Additional Declarations: No competing interests reported.

Figures

Figure 1
Figure 1. A schematic diagram of the sequential explanatory mixed methods design of the study.
Quantitative data was collected from five randomly selected facilities and informed the collection and analysis of the subsequent qualitative aspect of the study from three purposefully selected health facilities.
Figure 2
Figure 2
A depiction of the consolidated framework for implementation research (CFIR), indicating the five domains and its constructs [25]. three of the five domains of the CFIR, namely, the intervention, the inner setting and the characteristics of the individual were investigated.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP: Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. Journal of the American College of Cardiology 2020, 76(25):2982–3021. - PMC - PubMed
    1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A: Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 2020, 396(10258):1204–1222. - PMC - PubMed
    1. Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, Grunberger G, Guerin CK, Bell DS, Mechanick JI: American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocrine Practice 2017, 23:1–87. - PubMed
    1. Association AD: 10. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019, 42(Supplement 1):S103–S123. - PubMed
    1. Chait A, Subramanian S: Hypertriglyceridemia: pathophysiology, role of genetics, consequences, and treatment. Endotext [Internet] 2019.

Publication types

LinkOut - more resources