{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:57:50Z","timestamp":1791568670064,"version":"4.3.4"},"reference-count":85,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"RESPOND-AFRICA","award":["NIHR131273"],"award-info":[{"award-number":["NIHR131273"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Self-care practices were diverse and shaped by individuals\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      PROSPERO:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/CRD42023463738\" xlink:type=\"simple\">CRD42023463738<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360076","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:42:01Z","timestamp":1791567721000},"page":"e0360076","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Self-care practices of people living with HIV and hypertension or diabetes comorbidities in low-and-middle income countries: A systematic review"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0435-3666","authenticated-orcid":true,"given":"Andrew K.","family":"Tusubira","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine","place":["London, United Kingdom"],"department":["Department of Global Health and Development, Faculty of Public Health and Policy"]},{"name":"MRC\/ UVRI and LSHTM Uganda Research Unit","place":["Entebbe, Uganda"]},{"name":"Makerere University, College of Health Sciences","place":["Kampala, Uganda"],"department":["Department of Community Health and Behavioral Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0060-0842","authenticated-orcid":true,"given":"Andrew S.","family":"Ssemata","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine","place":["London, United Kingdom"],"department":["Department of Global Health and Development, Faculty of Public Health and Policy"]},{"name":"MRC\/ UVRI and LSHTM Uganda Research Unit","place":["Entebbe, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne R.","family":"Katahoire","sequence":"additional","affiliation":[{"name":"Child Health and Development Centre, Makerere University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"May","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine","place":["London, United Kingdom"],"department":["Department of Global Health and Development, Faculty of Public Health and Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine K.","family":"Nalwadda","sequence":"additional","affiliation":[{"name":"Makerere University, College of Health Sciences","place":["Kampala, Uganda"],"department":["Department of Community Health and Behavioral Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moffat","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"MRC\/ UVRI and LSHTM Uganda Research Unit","place":["Entebbe, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susannah","family":"Mayhew","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine","place":["London, United Kingdom"],"department":["Department of Global Health and Development, Faculty of Public Health and Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"pone.0360076.ref001","doi-asserted-by":"crossref","first-page":"102255","DOI":"10.1016\/j.eclinm.2023.102255","article-title":"The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: A systematic review and meta-analysis","volume":"65","author":"M Moyo-Chilufya","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pone.0360076.ref002","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12916-021-01981-y","article-title":"Global burden of hypertension in people living with HIV","volume":"19","author":"JJ Bigna","year":"2021","journal-title":"BMC Med"},{"issue":"7","key":"pone.0360076.ref003","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":"M Smit","year":"2015","journal-title":"The Lancet Infectious Diseases"},{"issue":"9","key":"pone.0360076.ref004","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1097\/HJH.0000000000002446","article-title":"Global burden of hypertension among people living with HIV in the era of increased life expectancy: A systematic review and meta-analysis","volume":"38","author":"JJ Bigna","year":"2020","journal-title":"J Hypertens"},{"issue":"1","key":"pone.0360076.ref005","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/s12879-025-12222-5","article-title":"Association between HIV infection and type 2 diabetes mellitus: Global incidence, prevalence, and risk factors - A systematic review and meta-analysis","volume":"26","author":"H Moameri","year":"2025","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0360076.ref006","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s12889-021-10318-6","article-title":"Prevalence and predictors of diabetes mellitus among persons living with HIV: A retrospective cohort study conducted in 4 public healthcare facilities in KwaZulu-Natal","volume":"21","author":"DM Umar","year":"2021","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0360076.ref007","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26059","article-title":"Prevalence and influences of diabetes and prediabetes among adults living with HIV in Africa: A systematic review and meta-analysis","volume":"26","author":"N Peer","year":"2023","journal-title":"J Int AIDS Soc"},{"issue":"11","key":"pone.0360076.ref008","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1093\/cid\/cir627","article-title":"Premature age-related comorbidities among HIV-infected persons compared with the general population","volume":"53","author":"G Guaraldi","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0360076.ref009","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1097\/QAD.0b013e328341f925","article-title":"Impact of NRTIs on lipid levels among a large HIV-infected cohort initiating antiretroviral therapy in clinical care","volume":"25","author":"HM Crane","year":"2011","journal-title":"AIDS"},{"key":"pone.0360076.ref010","article-title":"Antiretroviral therapy-induced metabolic alterations and risk of type 2 diabetes in people living with HIV","author":"MA Mahinda","year":"2023","journal-title":"Antiretroviral Ther"},{"issue":"1","key":"pone.0360076.ref011","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1186\/s12889-021-11698-5","article-title":"Experience of chronic noncommunicable disease in people living with HIV: A systematic review and meta-aggregation of qualitative studies","volume":"21","author":"Z Yang","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0360076.ref012","unstructured":"UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update 2023. Geneva: UNAIDS. 2023."},{"issue":"4","key":"pone.0360076.ref013","first-page":"418","article-title":"Self-care: A concept analysis","volume":"8","author":"N Mart\u00ednez","year":"2021","journal-title":"Int J Nurs Sci"},{"key":"pone.0360076.ref014","article-title":"Chronic disease self\u2010care: A concept analysis","author":"SN Tulu","year":"2021","journal-title":"Nurs Forum"},{"issue":"12","key":"pone.0360076.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-066647","article-title":"Factors influencing the integration of self-management in daily life routines in chronic conditions: A scoping review of qualitative evidence","volume":"12","author":"E Qama","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0360076.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001668","article-title":"Self-management of chronic, non-communicable diseases in South Asian settings: A systematic mixed-studies review","volume":"4","author":"F Siddiqui","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"10","key":"pone.0360076.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0003836","article-title":"Self-management of chronic conditions including multimorbidity in sub-Saharan Africa: A systematic and meta-synthesis review with focus on diabetes, hypertension, chronic kidney disease, and HIV","volume":"5","author":"SN Salimu","year":"2025","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"pone.0360076.ref018","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1186\/s12875-024-02586-z","article-title":"Treatment burden in multimorbidity: An integrative review","volume":"25","author":"JE Lee","year":"2024","journal-title":"BMC Prim Care"},{"issue":"1","key":"pone.0360076.ref019","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5334\/gh.1370","article-title":"Lessons learnt from HIV and noncommunicable disease healthcare integration in Sub-Saharan Africa","volume":"19","author":"JS van der Mannen","year":"2024","journal-title":"Glob Heart"},{"issue":"3","key":"pone.0360076.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0299904","article-title":"Integrated chronic care models for people with comorbid of HIV and non-communicable diseases in Sub-Saharan Africa: A scoping review","volume":"19","author":"R Chireshe","year":"2024","journal-title":"PLoS One"},{"issue":"5","key":"pone.0360076.ref021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-004669","article-title":"Integration of non-communicable disease and HIV\/AIDS management: A review of healthcare policies and plans in East Africa","volume":"6","author":"O Adeyemi","year":"2021","journal-title":"BMJ Glob Health"},{"key":"pone.0360076.ref022","doi-asserted-by":"crossref","first-page":"23259582251378538","DOI":"10.1177\/23259582251378538","article-title":"Hypertension burden and care cascade gaps among people living with HIV in an Urban HIV Clinic in Cameroon 2024","volume":"24","author":"C Kouanfack","year":"2025","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"10","key":"pone.0360076.ref023","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1177\/09564624231179497","article-title":"Diabetes mellitus care cascade among a cohort of persons living with HIV and hypertension in Uganda: A retrospective cohort study","volume":"34","author":"F Ambangira","year":"2023","journal-title":"Int J STD AIDS"},{"key":"pone.0360076.ref024","doi-asserted-by":"crossref","first-page":"1073246","DOI":"10.3389\/frph.2022.1073246","article-title":"Self-care can be an alternative to expand access to universal health care: What policy makers, governments and implementers can consider for South Africa","volume":"4","author":"A Nyatela","year":"2022","journal-title":"Front Reprod Health"},{"issue":"1","key":"pone.0360076.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(22)00451-X","article-title":"Self-care interventions and practices as essential approaches to strengthening health-care delivery","volume":"11","author":"M Narasimhan","year":"2023","journal-title":"Lancet Glob Health"},{"key":"pone.0360076.ref026","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1748-5908-4-29","article-title":"Development of a theory of implementation and integration: Normalization Process Theory","volume":"4","author":"CR May","year":"2009","journal-title":"Implement Sci"},{"issue":"3","key":"pone.0360076.ref027","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/0038038509103208","article-title":"Implementing, embedding, and integrating practices: An outline of normalization process theory","volume":"43","author":"C May","year":"2009","journal-title":"Sociology"},{"issue":"3","key":"pone.0360076.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000139","article-title":"Experiences of multimorbidity in urban and rural Malawi: An interview study of burdens of treatment and lack of treatment","volume":"2","author":"EF Chikumbu","year":"2022","journal-title":"PLOS Glob Public Health"},{"issue":"6","key":"pone.0360076.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001473","article-title":"Uncovering treatment burden as a key concept for stroke care: A systematic review of qualitative research","volume":"10","author":"K Gallacher","year":"2013","journal-title":"PLoS Med"},{"key":"pone.0360076.ref030","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1186\/1472-6963-14-281","article-title":"Rethinking the patient: Using burden of treatment theory to understand the changing dynamics of illness","volume":"14","author":"CR May","year":"2014","journal-title":"BMC Health Serv Res"},{"key":"pone.0360076.ref031","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1186\/1471-2288-12-181","article-title":"Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ","volume":"12","author":"A Tong","year":"2012","journal-title":"BMC Med Res Methodol"},{"key":"pone.0360076.ref032","doi-asserted-by":"crossref","first-page":"100198","DOI":"10.1016\/j.glmedi.2025.100198","article-title":"Using thematic analysis in qualitative research","volume":"6","author":"SK Ahmed","year":"2025","journal-title":"Journal of Medicine, Surgery, and Public Health"},{"issue":"1","key":"pone.0360076.ref033","doi-asserted-by":"crossref","first-page":"3446","DOI":"10.1186\/s12889-024-20763-8","article-title":"The impact of living with multiple long-term conditions (multimorbidity) on everyday life - A qualitative evidence synthesis","volume":"24","author":"E Holland","year":"2024","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0360076.ref034","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/10911359.2018.1482483","article-title":"Six domains of self-care: attending to the whole person","volume":"29","author":"LD Butler","year":"2019","journal-title":"J Hum Behav Soc Environ"},{"issue":"1","key":"pone.0360076.ref035","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1744-1609.2010.00196.x","article-title":"Care of self - care by other - care of other: The meaning of self-care from research, practice, policy and industry perspectives","volume":"9","author":"CM Godfrey","year":"2011","journal-title":"Int J Evid Based Healthc"},{"key":"pone.0360076.ref036","doi-asserted-by":"crossref","first-page":"103402","DOI":"10.1016\/j.ijnurstu.2019.103402","article-title":"Self-care research: Where are we now? Where are we going?","volume":"116","author":"B Riegel","year":"2021","journal-title":"Int J Nurs Stud"},{"key":"pone.0360076.ref037","unstructured":"Thomson R. EndNote\u00ae. http:\/\/www.endnote.com\/. 2020."},{"issue":"1","key":"pone.0360076.ref038","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1080\/1941126X.2018.1444339","article-title":"Rayyan for systematic reviews","volume":"30","author":"N Johnson","year":"2018","journal-title":"Journal of Electronic Resources Librarianship"},{"key":"pone.0360076.ref039","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"M Cumpston","year":"2024"},{"key":"pone.0360076.ref040","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"JP Higgins","year":"2024"},{"key":"pone.0360076.ref041","unstructured":"CASP. Critical appraisal skills programme (CASP). Qualitative checklist UK. 2019."},{"issue":"3","key":"pone.0360076.ref042","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/wvn.12134","article-title":"A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care","volume":"13","author":"A Butler","year":"2016","journal-title":"Worldviews Evid Based Nurs"},{"key":"pone.0360076.ref043","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"J Thomas","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"pone.0360076.ref044","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13012-017-0689-2","article-title":"Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 2: How to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table","volume":"13","author":"S Lewin","year":"2018","journal-title":"Implement Sci"},{"key":"pone.0360076.ref045","doi-asserted-by":"crossref","unstructured":"Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M. Applying GRADE-CERQual to qualitative evidence synthesis findings: Introduction to the series. Springer; 2018. p. 1\u201310.","DOI":"10.1186\/s13012-017-0688-3"},{"issue":"3","key":"pone.0360076.ref046","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-036551","article-title":"Systematic review of qualitative studies on participants in the decision-making process about the location of care of the elderly","volume":"10","author":"G Serrano-Gemes","year":"2020","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0360076.ref047","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1002\/nop2.1269","article-title":"A qualitative systematic review on the lived experience of men in nursing","volume":"9","author":"X Lyu","year":"2022","journal-title":"Nurs Open"},{"issue":"1","key":"pone.0360076.ref048","article-title":"Lay beliefs about hypertension among HIV-infected adults in Kenya","volume":"4","author":"TM Temu","year":"2017","journal-title":"Open Heart"},{"issue":"1","key":"pone.0360076.ref049","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1186\/s12889-025-21715-6","article-title":"Perceptions and management of diabetes and obesity among people living with HIV in C\u00f4te d\u2019Ivoire: A qualitative study","volume":"25","author":"JJ Koffi","year":"2025","journal-title":"BMC Public Health"},{"key":"pone.0360076.ref050","doi-asserted-by":"crossref","first-page":"1061190","DOI":"10.3389\/fmed.2023.1061190","article-title":"The impact of persistent precarity on patients\u2019 capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa","volume":"10","author":"M van Pinxteren","year":"2023","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"pone.0360076.ref051","doi-asserted-by":"crossref","DOI":"10.4102\/phcfm.v12i1.2472","article-title":"Lived experiences of human immunodeficiency virus and hypertension in the Eastern Cape, South Africa","volume":"12","author":"L Tokwe","year":"2020","journal-title":"Afr J Prim Health Care Fam Med"},{"issue":"2","key":"pone.0360076.ref052","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1177\/1049732320967917","article-title":"Patients\u2019 experiences of comorbid HIV\/AIDS and diabetes care and management in Soweto, South Africa","volume":"31","author":"EN Bosire","year":"2021","journal-title":"Qual Health Res"},{"issue":"3","key":"pone.0360076.ref053","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0194191","article-title":"A qualitative study on the experiences and perspectives of public sector patients in Cape Town in managing the workload of demands of HIV and type 2 diabetes multimorbidity","volume":"13","author":"R Matima","year":"2018","journal-title":"PLoS One"},{"issue":"1","key":"pone.0360076.ref054","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12913-022-08959-3","article-title":"\u201cAfter all, we are all sick\u201d: Multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda","volume":"23","author":"M Akugizibwe","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0360076.ref055","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1108\/JICA-06-2022-0033","article-title":"Women living with HIV, diabetes and\/or hypertension multi-morbidity in Uganda: A qualitative exploration of experiences accessing an integrated care service","volume":"31","author":"MCA Van Hout","year":"2022","journal-title":"JICA"},{"key":"pone.0360076.ref056","doi-asserted-by":"crossref","DOI":"10.1093\/heapol\/czz112","article-title":"\u201cBlood pressure can kill you tomorrow, but HIV gives you time\u201d: Illness perceptions and treatment experiences among Malawian individuals living with HIV and hypertension","volume":"34","author":"M Hing","year":"2019","journal-title":"Health Policy Plan"},{"issue":"5","key":"pone.0360076.ref057","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1080\/17441692.2021.1874468","article-title":"Health behaviours and beliefs among Malawian adults taking antihypertensive medication and antiretroviral therapy: A qualitative study","volume":"17","author":"C Moucheraud","year":"2022","journal-title":"Glob Public Health"},{"issue":"4","key":"pone.0360076.ref058","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/maq.12476","article-title":"When diabetes confronts HIV: Biological sub-citizenship at a public hospital in Nairobi, Kenya","volume":"32","author":"E Bosire","year":"2018","journal-title":"Med Anthropol Q"},{"issue":"12","key":"pone.0360076.ref059","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0243059","article-title":"\u201cIt\u2019s because I think too much\u201d: Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania","volume":"15","author":"P Manavalan","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0360076.ref060","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1186\/s12913-024-10688-8","article-title":"\u201cI only seek treatment when I am ill\u201d: Experiences of hypertension and diabetes care among adults living with HIV in urban Tanzania","volume":"24","author":"TA Ottaru","year":"2024","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0360076.ref061","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12912-025-02737-2","article-title":"Nursing approaches to self-care, self-management, and adaptation to illness","volume":"24","author":"\u00c5 Audulv","year":"2025","journal-title":"BMC Nurs"},{"issue":"8","key":"pone.0360076.ref062","doi-asserted-by":"crossref","first-page":"767","DOI":"10.17219\/acem\/191102","article-title":"Self-care: An effective strategy to manage chronic diseases","volume":"33","author":"P Iovino","year":"2024","journal-title":"Adv Clin Exp Med"},{"issue":"1","key":"pone.0360076.ref063","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5334\/aogh.3308","article-title":"Social support for self-care: Patient strategies for managing diabetes and hypertension in rural Uganda","volume":"87","author":"AK Tusubira","year":"2021","journal-title":"Ann Glob Health"},{"issue":"1","key":"pone.0360076.ref064","doi-asserted-by":"crossref","first-page":"2333","DOI":"10.1186\/s12889-022-14713-5","article-title":"Achieving the UNAIDS 90-90-90 targets: A comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa","volume":"22","author":"K Sabapathy","year":"2022","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0360076.ref065","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12981-024-00637-0","article-title":"Enhancing HIV treatment and support: A qualitative inquiry into client and healthcare provider perspectives on differential service delivery models in Uganda","volume":"21","author":"SP Katongole","year":"2024","journal-title":"AIDS Res Ther"},{"key":"pone.0360076.ref066","first-page":"1726","article-title":"Lived experiences of diabetic outpatients attending clinics in rural areas of Limpopo province in South Africa","volume":"28","author":"MH Mphasha","year":"2023","journal-title":"Health SA"},{"issue":"1","key":"pone.0360076.ref067","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-040650","article-title":"Patient experiences and perspectives on hypertension at a major referral hospital in rural southwestern Uganda: A qualitative analysis","volume":"11","author":"AG Herbst","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0360076.ref068","doi-asserted-by":"crossref","first-page":"693","DOI":"10.2147\/JMDH.S252300","article-title":"Systemic solutions for addressing non-communicable diseases in low- and middle-income countries","volume":"13","author":"A Ganju","year":"2020","journal-title":"J Multidiscip Healthc"},{"key":"pone.0360076.ref069","doi-asserted-by":"crossref","DOI":"10.2196\/51802","article-title":"Understanding gaps in the hypertension and diabetes care cascade: Systematic scoping review","volume":"10","author":"J Wang","year":"2024","journal-title":"JMIR Public Health Surveill"},{"issue":"1","key":"pone.0360076.ref070","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12981-021-00414-3","article-title":"Perceived satisfaction with HIV care and its association with adherence to antiretroviral therapy and viral suppression in the African Cohort Study","volume":"18","author":"N Somi","year":"2021","journal-title":"AIDS Res Ther"},{"issue":"5","key":"pone.0360076.ref071","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.26258","article-title":"Person-centred interventions to improve patient-provider relationships for HIV services in low- and middle-income countries: A systematic review","volume":"27","author":"LK Beres","year":"2024","journal-title":"J Int AIDS Soc"},{"issue":"3","key":"pone.0360076.ref072","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1093\/inthealth\/ihad080","article-title":"Prevalence and predictors of traditional medicine use among persons with diabetes in Africa: A systematic review","volume":"16","author":"E Ekpor","year":"2024","journal-title":"Int Health"},{"issue":"6","key":"pone.0360076.ref073","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2021-008138","article-title":"Use of traditional medicine and control of hypertension in 12 African countries","volume":"7","author":"C Lassale","year":"2022","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pone.0360076.ref074","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1186\/s12879-021-06862-6","article-title":"Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: A mixed-methods study","volume":"21","author":"Z Lukyamuzi","year":"2021","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0360076.ref075","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S1473-3099(24)00802-8","article-title":"Learning from AIDS for NCD control","volume":"25","author":"E Haslam","year":"2025","journal-title":"Lancet Infect Dis"},{"issue":"23","key":"pone.0360076.ref076","doi-asserted-by":"crossref","first-page":"12449","DOI":"10.3390\/ijerph182312449","article-title":"Preventing multimorbidity with lifestyle interventions in Sub-Saharan Africa: A new challenge for public health in low and middle-income countries","volume":"18","author":"A Alkhatib","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0360076.ref077","doi-asserted-by":"crossref","first-page":"7948712","DOI":"10.1155\/2020\/7948712","article-title":"Barriers and strategies to lifestyle and dietary pattern interventions for prevention and management of TYPE-2 diabetes in Africa, systematic review","volume":"2020","author":"H Bekele","year":"2020","journal-title":"J Diabetes Res"},{"issue":"16","key":"pone.0360076.ref078","doi-asserted-by":"crossref","first-page":"8376","DOI":"10.3390\/ijerph18168376","article-title":"Cultural considerations for the adaptation of a diabetes self-management education program in Cotonou, Benin: Lessons learned from a qualitative study","volume":"18","author":"H Alaof\u00e8","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"4","key":"pone.0360076.ref079","doi-asserted-by":"crossref","DOI":"10.1016\/S2352-3018(25)00325-X","article-title":"The impact of HIV stigma and discrimination on HIV testing, antiretroviral treatment, and viral suppression in Africa: A pooled analysis of population-based surveys","volume":"13","author":"CM Doyle","year":"2026","journal-title":"Lancet HIV"},{"issue":"2","key":"pone.0360076.ref080","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000706","article-title":"Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa","volume":"3","author":"AJ Bergman","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"pone.0360076.ref081","doi-asserted-by":"crossref","first-page":"758230","DOI":"10.3389\/fphys.2021.758230","article-title":"Pathophysiological consequences of at-risk alcohol use; implications for comorbidity risk in persons living with human immunodeficiency virus","volume":"12","author":"L Simon","year":"2022","journal-title":"Front Physiol"},{"key":"pone.0360076.ref082","doi-asserted-by":"crossref","first-page":"103713","DOI":"10.1016\/j.ijnurstu.2020.103713","article-title":"Characteristics of self-care interventions for patients with a chronic condition: A scoping review","volume":"116","author":"B Riegel","year":"2021","journal-title":"Int J Nurs Stud"},{"issue":"1","key":"pone.0360076.ref083","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/s12913-021-06433-0","article-title":"Coping with access barriers to non-communicable disease medicines: Qualitative patient interviews in eight counties in Kenya","volume":"21","author":"G Ng","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"pone.0360076.ref084","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0235696","article-title":"Accessing medicines for non-communicable diseases: Patients and health care workers\u2019 experiences at public and private health facilities in Uganda","volume":"15","author":"AK Tusubira","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0360076.ref085","doi-asserted-by":"crossref","first-page":"50","DOI":"10.18502\/sjms.v20i1.14340","article-title":"Eight in ten multimorbid patients experience high treatment burden: A cross-sectional survey in an outpatient setting","volume":"20","author":"I Ahmed","year":"2025","journal-title":"SJMS"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:42:13Z","timestamp":1791567733000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360076"}},"subtitle":[],"editor":[{"given":"Vanessa","family":"Carels","sequence":"first","affiliation":[{"name":"PLoS ONE","place":["UNITED STATES OF AMERICA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":85,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360076","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}