{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:58:39Z","timestamp":1791615519285,"version":"4.3.4"},"reference-count":58,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T00:00:00Z","timestamp":1572566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100017823","name":"UCLA Center for AIDS Research","doi-asserted-by":"crossref","award":["5P30AI028697"],"award-info":[{"award-number":["5P30AI028697"]}],"id":[{"id":"10.13039\/100017823","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Non-communicable diseases like hypertension are increasingly common among individuals living with HIV in low-resource settings. The prevalence of hypertension among people with HIV in Malawi, e.g. has been estimated to be as high as 46%. However, few qualitative studies have explored the patient experience with comorbid chronic disease. Our study aimed to address this gap by using the health belief model (HBM) to examine how comparative perceptions of illness and treatment among participants with both HIV and hypertension may affect medication adherence behaviours. We conducted semi-structured interviews with 75 adults with HIV and hypertension at an urban clinic in Lilongwe, Malawi. Questions addressed participants\u2019 experiences with antiretroviral and antihypertensive medications, as well as their perspectives on HIV and hypertension as illnesses. Interviews were performed in Chichewa, transcribed, translated into English and analysed using ATLAS.ti. Deductive codes were drawn from the HBM and interview guide, with inductive codes added as they emerged from the data. Self-reported medication adherence was much poorer for hypertension than HIV, but participants saw hypertension as a disease at least as concerning as HIV\u2014primarily due to the perceived severity of hypertension\u2019s consequences and participants\u2019 limited ability to anticipate them compared with HIV. Differences in medication adherence were attributed to the high costs of antihypertensive medications relative to the free availability of antiretroviral therapy, with other factors like lifestyle changes and self-efficacy also influencing adherence practices. These findings demonstrate how participants draw on past experiences with HIV to make sense of hypertension in the present, and suggest that although patients are motivated to control their hypertension, they face individual- and system-level obstacles in adhering to treatment. Thus, health policies and systems seeking to provide integrated care for HIV and hypertension should be attentive to the complex illness experiences of individuals living with these diseases.<\/jats:p>","DOI":"10.1093\/heapol\/czz112","type":"journal-article","created":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T19:31:14Z","timestamp":1567798274000},"page":"ii36-ii44","source":"Crossref","is-referenced-by-count":33,"title":["\u2018Blood pressure can kill you tomorrow, but HIV gives you time\u2019: illness perceptions and treatment experiences among Malawian individuals living with HIV and hypertension"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5349-2879","authenticated-orcid":false,"given":"Matthew","family":"Hing","sequence":"first","affiliation":[{"name":"Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa M","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA, USA"},{"name":"Partners in Hope, (Area 36\/Plot 8), Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet","family":"Seleman","sequence":"additional","affiliation":[{"name":"Partners in Hope, (Area 36\/Plot 8), Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Chibwana","sequence":"additional","affiliation":[{"name":"Partners in Hope, (Area 36\/Plot 8), Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California Los Angeles, David Geffen School of Medicine, Le Conte Ave, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7862-7928","authenticated-orcid":false,"given":"Corrina","family":"Moucheraud","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, University of California Los Angeles, Fielding School of Public Health, 650 Charles E Young Dr S, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,13]]},"reference":[{"key":"2021031605275014700_czz112-B1","first-page":"28","article-title":"The health belief model","volume":"2","author":"Abraham","year":"2005","journal-title":"Predicting Health Behaviour"},{"key":"2021031605275014700_czz112-B2","first-page":"257","article-title":"Quality of integrated chronic disease care in rural South Africa: user and provider perspectives","volume":"32","author":"Ameh","year":"2017","journal-title":"Health Policy and Planning"},{"key":"2021031605275014700_czz112-B3","doi-asserted-by":"crossref","first-page":"e411","DOI":"10.1016\/S2468-2667(17)30141-X","article-title":"Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: an analysis of the PURE study data","volume":"2","author":"Attaei","year":"2017","journal-title":"The Lancet Public Health"},{"key":"2021031605275014700_czz112-B4","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/S0140-6736(13)60063-X","article-title":"Improving responsiveness of health systems to non-communicable diseases","volume":"381","author":"Atun","year":"2013","journal-title":"The Lancet"},{"key":"2021031605275014700_czz112-B5","doi-asserted-by":"crossref","first-page":"e35515.","DOI":"10.1371\/journal.pone.0035515","article-title":"Self care behavior among patients with diabetes in Harari, Eastern Ethiopia: the health belief model perspective","volume":"7","author":"Ayele","year":"2012","journal-title":"PLoS One"},{"key":"2021031605275014700_czz112-B6","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1016\/S0140-6736(11)60393-0","article-title":"Priority actions for the non-communicable disease crisis","volume":"377","author":"Beaglehole","year":"2011","journal-title":"The Lancet"},{"key":"2021031605275014700_czz112-B7","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/S0140-6736(18)31992-5","article-title":"NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4","volume":"392","author":"Bennett","year":"2018","journal-title":"The Lancet"},{"key":"2021031605275014700_czz112-B8","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1016\/j.socscimed.2011.02.030","article-title":"Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV\/AIDS in Cameroon: individual and healthcare supply-related factors","volume":"72","author":"Boyer","year":"2011","journal-title":"Social Science & Medicine"},{"key":"2021031605275014700_czz112-B9","first-page":"45","article-title":"The health belief model","volume":"4","author":"Champion","year":"2008","journal-title":"Health Behavior and Health Education: Theory, Research, and Practice"},{"key":"2021031605275014700_czz112-B10","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.socscimed.2018.03.030","article-title":"Doing patient-centredness versus achieving public health targets: a critical review of interactional dilemmas in ART adherence support","volume":"205","author":"De Kok","year":"2018","journal-title":"Social Science & Medicine"},{"key":"2021031605275014700_czz112-B11","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1080\/09540120410001683358","article-title":"Factors influencing acceptability of voluntary counselling and HIV-testing among pregnant women in Northern Tanzania","volume":"16","author":"De Paoli","year":"2004","journal-title":"AIDS Care"},{"key":"2021031605275014700_czz112-B12","doi-asserted-by":"crossref","first-page":"1243.","DOI":"10.1186\/s12889-016-3916-x","article-title":"The burden of hypertension, diabetes mellitus, and cardiovascular risk factors among adult Malawians in HIV care: consequences for integrated services","volume":"16","author":"Divala","year":"2016","journal-title":"BMC Public Health"},{"key":"2021031605275014700_czz112-B13","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1080\/09540120701694022","article-title":"Sustained antiretroviral treatment adherence in survivors of the pre-HAART era: attitudes and beliefs","volume":"20","author":"Fumaz","year":"2008","journal-title":"AIDS Care"},{"key":"2021031605275014700_czz112-B14","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1002\/9781118410868.wbehibs410","article-title":"Health belief model","author":"Green","year":"2014","journal-title":"The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society"},{"key":"2021031605275014700_czz112-B15","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1093\/her\/7.1.107","article-title":"A meta-analysis of studies of the health belief model with adults","volume":"7","author":"Harrison","year":"1992","journal-title":"Health Education Research"},{"key":"2021031605275014700_czz112-B16","doi-asserted-by":"crossref","first-page":"e000125.","DOI":"10.1136\/bmjgh-2016-000125","article-title":"Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review","volume":"1","author":"Heestermans","year":"2016","journal-title":"BMJ Global Health"},{"key":"2021031605275014700_czz112-B17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/109019818401100101","article-title":"The health belief model: a decade later","volume":"11","author":"Janz","year":"1984","journal-title":"Health Education Quarterly"},{"key":"2021031605275014700_czz112-B18","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1016\/j.socscimed.2012.07.015","article-title":"Hidden costs: the direct and indirect impact of user fees on access to malaria treatment and primary care in Mali","volume":"75","author":"Johnson","year":"2012","journal-title":"Social Science & Medicine"},{"key":"2021031605275014700_czz112-B19","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.1097\/QAD.0000000000001879","article-title":"From HIV prevention to non-communicable disease health promotion efforts in sub-Saharan Africa: a narrative review","volume":"32","author":"Juma","year":"2018","journal-title":"AIDS"},{"key":"2021031605275014700_czz112-B20","doi-asserted-by":"crossref","first-page":"e0151106.","DOI":"10.1371\/journal.pone.0151106","article-title":"Structural determinants of antiretroviral therapy use, HIV care attendance, and viral suppression among adolescents and young adults living with HIV","volume":"11","author":"Kahana","year":"2016","journal-title":"PLoS One"},{"key":"2021031605275014700_czz112-B21","doi-asserted-by":"crossref","first-page":"46.","DOI":"10.1186\/s12875-017-0613-5","article-title":"A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa","volume":"18","author":"Kane","year":"2017","journal-title":"BMC Family Practice"},{"key":"2021031605275014700_czz112-B22","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.amjmed.2008.11.013","article-title":"Adherence to healthy lifestyle habits in US adults, 1988\u20132006","volume":"122","author":"King","year":"2009","journal-title":"The American Journal of Medicine"},{"key":"2021031605275014700_czz112-B23","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/BF01674233","article-title":"Patient adherence to antihypertensive medical regimens","volume":"3","author":"Kirscht","year":"1977","journal-title":"Journal of Community Health"},{"key":"2021031605275014700_czz112-B24","doi-asserted-by":"crossref","first-page":"1690S","DOI":"10.3945\/ajcn.111.019075","article-title":"Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings\u2014insights from South Africa","volume":"94","author":"Levitt","year":"2011","journal-title":"The American Journal of Clinical Nutrition"},{"key":"2021031605275014700_czz112-B25","volume-title":"Malawi Noncommunicable Diseases & Injuries Poverty Commission Report","author":"Health","year":"2018"},{"key":"2021031605275014700_czz112-B26","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1001\/archinternmed.2007.119","article-title":"Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004","volume":"168","author":"Mellen","year":"2008","journal-title":"Archives of Internal Medicine"},{"key":"2021031605275014700_czz112-B27","doi-asserted-by":"crossref","first-page":"115.","DOI":"10.1037\/0278-6133.4.2.115","article-title":"Common-sense models of illness: the example of hypertension","volume":"4","author":"Meyer","year":"1985","journal-title":"Health Psychology"},{"key":"2021031605275014700_czz112-B28","year":"2011"},{"key":"2021031605275014700_czz112-B29","year":"2010"},{"key":"2021031605275014700_czz112-B30","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1377\/hlthaff.22.4.220","article-title":"Medication costs, adherence, and health outcomes among Medicare beneficiaries","volume":"22","author":"Mojtabai","year":"2003","journal-title":"Health Affairs"},{"key":"2021031605275014700_czz112-B31","doi-asserted-by":"crossref","first-page":"488.","DOI":"10.1186\/1472-6963-13-488","article-title":"Medication adherence in HIV-positive patients with diabetes or hypertension: a focus group study","volume":"13","author":"Monroe","year":"2013","journal-title":"BMC Health Services Research"},{"key":"2021031605275014700_czz112-B32","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1377\/hlthaff.2018.0151","article-title":"Service readiness for noncommunicable diseases was low in five countries in 2013\u201315","volume":"37","author":"Moucheraud","year":"2018","journal-title":"Health Affairs"},{"key":"2021031605275014700_czz112-B33","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1377\/hlthaff.2015.1445","article-title":"PEPFAR investments in governance and health systems were one-fifth of countries\u2019 budgeted funds, 2004\u201314","volume":"35","author":"Moucheraud","year":"2016","journal-title":"Health Affairs"},{"key":"2021031605275014700_czz112-B34","doi-asserted-by":"crossref","first-page":"e20316.","DOI":"10.1371\/journal.pone.0020316","article-title":"The burden of selected chronic non-communicable diseases and their risk factors in Malawi: nationwide STEPS survey","volume":"6","author":"Msyamboza","year":"2011","journal-title":"PLoS One"},{"key":"2021031605275014700_czz112-B35","doi-asserted-by":"crossref","first-page":"104.","DOI":"10.1186\/1471-2458-7-104","article-title":"A review of health behaviour theories: how useful are these for developing interventions to promote long-term medication adherence for TB and HIV\/AIDS?","volume":"7","author":"Munro","year":"2007","journal-title":"BMC Public Health"},{"key":"2021031605275014700_czz112-B36","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.trstmh.2011.07.016","article-title":"Cardiovascular risk factors in adult Malawians on long-term antiretroviral therapy","volume":"105","author":"Muronya","year":"2011","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"key":"2021031605275014700_czz112-B37","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1093\/heapol\/czw080","article-title":"Persistent low adherence to hypertension treatment in Kyrgyzstan: how can we understand the role of drug affordability?","volume":"31","author":"Murphy","year":"2016","journal-title":"Health Policy and Planning"},{"key":"2021031605275014700_czz112-B38","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1097\/QAD.0000000000001887","article-title":"Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps","volume":"32","author":"Njuguna","year":"2018","journal-title":"AIDS"},{"key":"2021031605275014700_czz112-B39","author":"Nugent","year":"2010"},{"key":"2021031605275014700_czz112-B40","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1097\/QAD.0000000000001878","article-title":"Building reliable supply chains for noncommunicable disease commodities: lessons learned from HIV and evidence needs","volume":"32","author":"Pastakia","year":"2018","journal-title":"AIDS"},{"key":"2021031605275014700_czz112-B41","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1097\/QAD.0000000000001888","article-title":"Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis","volume":"32","author":"Patel","year":"2018","journal-title":"AIDS"},{"key":"2021031605275014700_czz112-B42","doi-asserted-by":"crossref","first-page":"e1002523","DOI":"10.1371\/journal.pmed.1002523","article-title":"Integrating HIV and hypertension management in low-resource settings: lessons from Malawi","volume":"15","author":"Patel","year":"2018","journal-title":"PLoS Medicine"},{"key":"2021031605275014700_czz112-B43","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/phcfm.v9i1.1151","article-title":"You can treat my HIV\u2014but can you treat my blood pressure? Availability of integrated HIV and non-communicable disease care in northern Malawi","volume":"9","author":"Pfaff","year":"2017","journal-title":"African Journal of Primary Health Care & Family Medicine"},{"key":"2021031605275014700_czz112-B44","first-page":"5","volume-title":"The Health Belief Model and HIV Risk Behavior Change. Preventing AIDS","author":"Rosenstock","year":"1994"},{"key":"2021031605275014700_czz112-B45","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1016\/S0140-6736(10)61353-0","article-title":"Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries","volume":"376","author":"Samb","year":"2010","journal-title":"The Lancet"},{"key":"2021031605275014700_czz112-B46","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/S1473-3099(15)00056-0","article-title":"Future challenges for clinical care of an ageing population infected with HIV: a modelling study","volume":"15","author":"Smit","year":"2015","journal-title":"The Lancet Infectious Diseases"},{"key":"2021031605275014700_czz112-B47","doi-asserted-by":"crossref","first-page":"e0199602.","DOI":"10.1371\/journal.pone.0199602","article-title":"A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care","volume":"13","author":"Stockton","year":"2018","journal-title":"PLoS One"},{"key":"2021031605275014700_czz112-B48","volume-title":"Ending AIDS: Progress towards the 90\u201390\u201390 targets. Global AIDS Update","year":"2017"},{"key":"2021031605275014700_czz112-B49","doi-asserted-by":"crossref","first-page":"687.","DOI":"10.1038\/jhh.2017.48","article-title":"Factors associated with antihypertensive medication non-adherence: a systematic review","volume":"31","author":"van der Laan","year":"2017","journal-title":"Journal of Human Hypertension"},{"key":"2021031605275014700_czz112-B50","doi-asserted-by":"crossref","first-page":"e0164634.","DOI":"10.1371\/journal.pone.0164634","article-title":"\u201cThey just come, pick and go.\u201d The acceptability of integrated medication adherence clubs for HIV and non communicable disease (NCD) patients in Kibera, Kenya","volume":"11","author":"Venables","year":"2016","journal-title":"PLoS One"},{"key":"2021031605275014700_czz112-B51","doi-asserted-by":"crossref","first-page":"e361","DOI":"10.1016\/S2352-3018(16)30087-X","article-title":"Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980\u20132015: the Global Burden of Disease Study 2015","volume":"3","author":"Wang","year":"2016","journal-title":"The Lancet HIV"},{"key":"2021031605275014700_czz112-B52","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1093\/heapol\/czu004","article-title":"Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi","volume":"30","author":"Wang","year":"2015","journal-title":"Health Policy and Planning"},{"key":"2021031605275014700_czz112-B53","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1016\/j.socscimed.2009.02.037","article-title":"\u201cIt\u2019s all the time in my mind\u201d: Facilitators of adherence to antiretroviral therapy in a Tanzanian setting","volume":"68","author":"Watt","year":"2009","journal-title":"Social Science & Medicine"},{"key":"2021031605275014700_czz112-B54","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/S0140-6736(16)31599-9","article-title":"Essential medicines for universal health coverage","volume":"389","author":"Wirtz","year":"2017","journal-title":"Lancet (London, England)"},{"key":"2021031605275014700_czz112-B55","year":"2017"},{"key":"2021031605275014700_czz112-B56","year":"2019"},{"key":"2021031605275014700_czz112-B57","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.hjdsi.2015.08.002","article-title":"Leveraging HIV platforms to work toward comprehensive primary care in rural Malawi: the Integrated Chronic Care Clinic","volume":"3","author":"Wroe","year":"2015","journal-title":"Healthcare"},{"key":"2021031605275014700_czz112-B58","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s41256-018-0082-y","article-title":"Experiences of type 2 diabetes in sub-Saharan Africa: a scoping review","volume":"3","author":"Zimmermann","year":"2018","journal-title":"Global Health Research and Policy"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/heapol\/article-pdf\/34\/Supplement_2\/ii36\/36608171\/czz112.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/heapol\/article-pdf\/34\/Supplement_2\/ii36\/36608171\/czz112.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T05:36:52Z","timestamp":1615873012000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/34\/Supplement_2\/ii36\/5625035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,1]]},"references-count":58,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2019,11,13]]},"published-print":{"date-parts":[[2019,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czz112","relation":{},"ISSN":["0268-1080","1460-2237"],"issn-type":[{"value":"0268-1080","type":"print"},{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,11]]},"published":{"date-parts":[[2019,11,1]]}}}