Table 3 Codes, categories, and themes on the access to care for HTN/DM and coping strategies among ALHIV in Dar-es-Salaam, 2022
Themes | Categories | Code |
|---|---|---|
Availability | Limited availability of screening services for HTN/DM at the HIV CTC | Inconsistency in BP measurement services at HIV CTCs |
Lack of diabetes screening at the HIV CTCs | ||
Lack of anti-hypertensives and diabetes medication at the HIV CTC | Advised to seek treatment (including medication) at other facilities | |
HTN/DM medication not within HIV CTCs provided services | ||
Accommodation | Perceived complexity of HTN/DM care at NCD clinics | Uncoordinated service delivery systems |
Uncoordinated appointment schedules | ||
Preference for HIV/NCD integrated care at the HIV CTCs | ||
Lack of (tailored) patient education that meets ALHIV comorbidities care needs | Inadequate patient education on HTN/DM management | |
Contradicting patient education information on multimorbidity management | ||
Participant desire for comprehensive HTN/DM management discussions with healthcare providers | ||
Affordability | Unaffordable cost of HTN/DM medication | Purchasing medication only when symptoms become overwhelming |
Inability to afford more comprehensive health insurance plans | ||
HTN/DM medication are not covered by the insurance plans they can afford | ||
Unaffordable consultation costs at HTN/DM clinics | Stopped medical visits due to consultation costs | |
Acceptability | Fear of side effects of HTN/DM medication | Fear of symptoms experienced after multiple medication use |
Fear of side effects believed to be caused by multiple medication use | ||
Fear of life-long use of multiple medications | ||
Perceived ineffectiveness of HTN/DM medication | Poor control of HTN/DM after a perceived long-term use of pharmaceutical medication | |
Perceived improved HTN/DM control through herbal medication use | ||
Belief in alternative approaches (sleeping, drinking water, use of garlic) to control blood pressure | ||
Accessibility | High transportation costs to the HTN/DM clinic | High transport costs related to the need to attend multiple clinics (NCD clinic and HIV CTC) scheduled on different dates within the same facility |
High transport costs related to the necessity of attending NCD clinics at a different facility from where the HIV CTC is located | ||
Coping strategies | Adaptive coping strategies | Seeking financial assistance from family, community, and church members |
Reliance on lifestyle modification; physical exercise and balanced diet | ||
Reliance on lower-level facilities e.g., dispensaries, and community pharmacies near home for management | ||
Maladaptive coping strategies | Use of perceived cheaper herbal remedies to control HTN/DM | |
Self-monitoring of symptoms at home, eliminating the need to visit health facilities | ||
Intermittent use of medication |