The challenge of dealing with non-AIDS comorbidities for people living with HIV: Perspectives and experiences of patients and healthcare providers

Figures & data

Figure 1. The Diamond Model, adapted from Melles et al. (2020), which visualises the human-centred design process. The diamond is used to discover and define the challenges faced by the older HIV patient.

Table 1. Interview guide based on the normalisation practice theory (NPT)

NPT construct	Provider's questions	Patient's questions
Coherence	What do you think are NARCs in the context of HIV? Can you give an example of a case in which you established a NARC? - How often do you assess/see NARCs in PLHIV? What recommendations do you give to your patients at high risk of NARCs? - What kind of information are your recommendations based on? In your opinion, how should we address NARCs in PLHIV in your clinical setting? What is your experience with geriatric assessment? - Do you think it is necessary to screen for NARCs among your patients?	Based on the conditions you have previously mentioned, how do you differentiate those that are HIV-related from those that are age-related? What does it mean to you to have symptoms/signs of an illness not related to HIV? How did you feel about having to make lifestyle and behavioural changes based on the possibility of developing age-related comorbidities in the future? How important was it/would it be to make these changes, why?
Cognitive participation	Describe the interaction/conversations you have with medical staff about the risk of NARCs for PLHIV?	Did you/would you get others to join in on these changes? How did you/would you do that? What professional help and advice were you given to achieve these changes? How much do you rely on your doctor(s) expertise to implement these changes? What do you do when you need to talk about something or when something is bothering you? Where would you turn? (Family, friends, professionals, the internet)
Collective action	(Why) do you choose to (not) diagnose/screen NARCs? How do you think that geriatric assessment could fit in a typical working day? Do you have confidence in the performance of your colleagues in carrying out a geriatric assessment when this is put in place?	How achievable did/would making these changes seem to you? How have you managed these? What help were you given from your doctor(s) to manage these?
Reflexive monitoring	What are your goals when caring for your patients? Do you have specific goals for caring for patients with NARCs? If yes, what goals? Do you collect information on NARCs s? What information would you find useful to obtain? What do you consider when developing these goals?	How worthwhile do you think it was/it would be to make the changes? How confident do you feel about being able to continue with the changes in the long term? How do you feel about having review appointments annually?

Table 2. Focus group discussion interview guide.

	Question leading the provider FDG	Question leading the patient FDG
Part 1	What do you consider the biggest challenge in geriatric care? (List Top Five)	What do you consider the biggest challenge when ageing with HIV? (List Top Five)
Part 2	Do you screen for NARCs? - If no: Do you think this is necessary? How do you feel about screening? - If yes: When do you screen? What makes caring for older PLHIV difficult? What are barriers to screening? How do you feel about this? Is there something you can do to overcome this barrier?	What is your condition(s) a result of? HIV HIV treatment (ART) ageing lifestyle Has your doctor ever described to you this possibility? Do you believe you were adequately trained to manage your conditions? When diagnosed HIV-positive, what advice were you given by your doctor(s)? What advice are you applying in practice? What advice do you take more seriously? In your opinion, what are HIV health services missing in your country? How can we make health services ideal for you?

Table 3. Demographics of study participants.

Participant characteristics	n (%)
Patients (n = 15)
Gender
Female	9 (60)
Male	6 (40)
Average age at HIV diagnosis	44
Average current age	60
Average number of years living with HIV	16
Average years taking ART medication	15
Prescription medications apart from ART
Antihypertensive drug	4 (27)
Antidiabetic drug	7 (46)
Antihypertensive drug + Antidiabetic drug	4 (27)
Providers (N = 12)
Highest Education
Certificate	0 (0)
Diploma	2 (17)
Degree	10 (83)
Professional Cadre
Nurse	2 (17)
Doctor	7 (58)
Health Officer	3 (25)
Years of clinical experience with PLHIV
1–4 years	7 (58)
4–10 years	5 (42)
Location
Arba Minch General Hospital	6 (50)
Gidole Primary Hospital	3 (25)
Chencha Primary Hospital	3 (25)
Additional trainings
TB/HIV co infections	5 (42)
Prevention of mother-to-child transmission	3 (25)
ART therapy	5 (42)
HIV counselling and testing	4 (33)
NCD co-morbidities	2 (17)
Paediatrics and adolescent HIV	5 (42)
Sexual and reproductive Health	4 (33)

ART = Antiretroviral treatment; MSM = Men who have sex with men; PLHIV = People Living with HIV.

Figure 2. Diamond Model visualisation of ageing with HIV.

Melles, M., Albayrak, A., & Goossens, R. (2020). Innovating health care: Key characteristics of human-centered design. International Journal for Quality in Health Care, 33(Supplement_1), 37–44. https://doi.org/10.1093/intqhc/mzaa127

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