Improving osteoporosis prevention and care for patients with HIV: insights from HIV care providers in China

Osteoporosis has emerged as an important comorbidity for people living with HIV (PLWH) as life expectancy for this population has increased in the anti-retroviral therapy era. In countries lacking a robust primary care system such as China, chronic co-morbidities of HIV such as osteoporosis and fractures may be particularly under-recognized. Understanding barriers and opportunities for integration of bone health promotion strategies into current HIV care settings can aid in bone health program development and may provide a model of primary/secondary preventive care that is currently lacking. Adopting grounded theory approach, we conducted a qualitative research study between April-July 2021. In-depth interviews were carried out with 13 HIV care providers, including physicians and nurses involved in both clinical care and coordination of HIV care services, from four cities across China. Two independent coders applied the constant comparison method for transcript analysis on providers’ current knowledge and practices on bone health in HIV, as well as opportunities and barriers to future program development. Interviewed providers recognized osteoporosis as a topic of increasing importance in long-term HIV care yet conceded that bone health received less priority than other aging-related comorbidities in routine HIV care. They reported receiving little formalized training on managing osteoporosis and limited access to education on this topic due to financial and human resources constraints. However, providers saw significant potential for program development in three key areas: creation and adoption of population-specific guidelines for osteoporosis prevention, screening, and management practices; increased access to training regarding osteoporosis screening, interpretation of results, and management algorithms; and development of structured interdisciplinary care services and referral networks. Osteoporosis is an issue of increasing importance for the comprehensive care of PLWH. Population-specific recommendations on prevention, screening and management of osteoporosis, targeted education programs and tools, and innovative interdisciplinary expansion of current HIV care networks were identified by HIV care providers as key strategies for osteoporosis and fracture prevention and broader promoting bone health among Chinese PLWH.