Self-care practices of people living with HIV and hypertension or diabetes comorbidities in low-and-middle income countries: A systematic review
TL;DR
Self-care practices were diverse and shaped by individuals’ interpretations of illnesses, structural inequities, and the cumulative demands of multimorbidity, and future research should quantify self-care workload and treatment burden and evaluate integrated care models that reduce patient workload.
Abstract
Background People living with HIV in low-and middle-income countries (LMICs) face a growing burden of hypertension and diabetes comorbidities. Although self-care is essential, limited evidence exists on how patients manage these conditions concurrently within resource-constrained settings. We examined self-care practices among people living with HIV and hypertension or diabetes comorbidities in LMICs and identified treatment burdens related to these practices. Methods We searched Medline, EMBASE, PsycINFO, Global Health, Scopus, Web of Science, CINAHL, WHO Global Index Medicus, African Journals Online and, Google Scholar for primary studies conducted in LMICs and published between January 2013 and March 2026, regardless of study design and data collection method. Two reviewers independently screened, extracted data, and assessed study quality, resolving discrepancies through discussions. We used thematic synthesis to analyze self-care practices, and mapped findings onto the Normalization Process Theory to identify associated treatment burdens. Confidence in the evidence was assessed using the GRADE-CERQual approach. Results Thirteen qualitative studies from six African countries, comprising 458 participants, were included. Seven studies were rated high quality while six were moderate. Five themes emerged with moderate-to-high confidence in evidence: 1) Sense-making of illnesses and medications; 2) Divergent treatment approaches between HIV and hypertension or diabetes treatment; 3) Adoption of health-promoting behaviors, including lifestyle changes; 4) Coping with psychosocial distress, and 5) Strategies to navigate healthcare insecurities. Related treatment burdens were linked to prescribed healthcare tasks, disparities between HIV and hypertension/diabetes care, and patient-initiated efforts to compensate for gaps in hypertension/diabetes care. Conclusion Self-care practices were diverse and shaped by individuals’ interpretations of illnesses, structural inequities, and the cumulative demands of multimorbidity. Strengthening consistent education on illness and medications, psychosocial support, and lifestyle guidance can improve equitable integrated care and support effective self-care. Future research should quantify self-care workload and treatment burden and evaluate integrated care models that reduce patient workload. Systematic review registration PROSPERO: CRD42023463738.