Exploring barriers and facilitators for non-communicable disease care for persons living with HIV in Peru through a socioecological framework: HIV physician and coordinator perspectives

As the population of persons living with HIV (PLWH) ages, the Peruvian National HIV, STI and Hepatitis Program (NHSTIHP) faces the question of how best to provide care for non-communicable diseases (NCDs) among PLWH. Using a qualitative approach, this study explores the barriers and facilitators of providing NCD care to PLWH in Peru through the perspective of NHSTIHP physicians and coordinators. HIV regional program coordinators and physicians affiliated with Peru’s NHSTIHP were recruited for individual in-depth interviews from the Program’s physician and coordinator registry and by peer referral. Interviews continued until thematic saturation was reached in both groups. The emerging themes were visualized using an adapted socioecological framework. All regional coordinators who volunteered (N = 25) were interviewed. Physicians were sampled to ensure variability in training background and region, and 14 physicians were interviewed to reach thematic saturation. Barriers and facilitators discussed by both groups were organized into major themes following a socioecological model: patient, provider, local clinic/hospital, regional, and national health system. Peru-specific themes identified included: concern about practicing outside of one’s specialty (“intrusismo”), patient trust, the role of HIV coordinators and insurance, and the importance of national clinical practice guidelines. This study highlights the complex interplay between patient, provider, local, regional, and national factors that influence delivery of care to PLWH in Peru. Addressing the barriers will require co-creation of resource-adaptable national HIV guidelines, with the participation of providers, program coordinators, and patients. These guidelines should encompass not only NCD management and educational resources for HIV providers and patients, but also processes and implementation pathways. This will require coordination between existing NCD and HIV health programs, and generation of epidemiologic data on NCD in PLWH to optimize resource allocation.