{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:58:02Z","timestamp":1792612682683,"version":"4.5.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The rise in non-communicable diseases (NCD), such as hypertension and diabetes among people living with human immunodeficiency virus (PLWH), has increased the demand for integrated care due to multiple chronic care needs. However, there is a dearth of evidence on contextual factors implementing integrated hypertension and diabetes care with HIV care. This study aimed to identify facilitators and barriers that could affect the integration of hypertension and diabetes with HIV care at primary health care in Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five primary health facilities from five districts of the Wolaita zone of South Ethiopia were included in the qualitative study. Fifteen key informant interviews were conducted with healthcare providers and managers from the zonal, district, and facility levels from October to November 2022. Data collection and analysis were guided by a consolidated framework of implementation research (CFIR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten CFIR constructs were found to influence the integration. Perceived benefit of integration to patients, healthcare providers, and organization; perceived possibilities of integration implementation; availability of NCD guidelines and strategies; a supportive policy of decentralization and integration; perceived leaders and healthcare provider commitment were found to be facilitators. Perceived increased cost, insufficient attention to NCD care needs, inadequate number of trained professionals, inadequate equipment and apparatus such as blood pressure measurement, glucometers, strips, and NCD drugs, inadequate allocation of budget and weak health financing system and poor culture of data capturing and reporting were identified as barriers to integration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It is important to address contextual barriers through innovative implementation science solutions to address multiple chronic care needs of PLWH by implementing integrated hypertension and diabetes with HIV care in primary healthcare. Training and task shifting, pairing experienced professionals, and strengthening the health care financing system to implement evidence-based integration of hypertension and diabetes are recommended.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1247121","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T18:49:40Z","timestamp":1702061380000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":26,"title":["Facilitators and barriers to integration of noncommunicable diseases with HIV care at primary health care in Ethiopia: a qualitative analysis using CFIR"],"prefix":"10.3389","volume":"11","author":[{"given":"Abebe Sorsa","family":"Badacho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozayr Haroon","family":"Mahomed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0000084","DOI":"10.1371\/journal.pgph.0000084","article-title":"Integrated healthcare services for HIV, diabetes mellitus and hypertension in selected health facilities in Kampala and Wakiso districts, Uganda: a qualitative methods study","volume":"2","author":"Bukenya","year":"2022","journal-title":"PLoS Global Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e1375","DOI":"10.1016\/S2214-109X(19)30374-2","article-title":"Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017","volume":"7","author":"Gouda","year":"2019","journal-title":"Lancet Glob Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"36","DOI":"10.2174\/1874613601913010036","article-title":"Immunologic restoration of people living with human immunodeficiency virus on highly active anti-retroviral therapy in Ethiopia: the focus of chronic Non-Communicable disease co-morbidities","volume":"13","author":"Melaku","year":"2019","journal-title":"Open AIDS J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1744-8603-5-9","article-title":"A review of co-morbidity between infectious and chronic disease in sub Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization","volume":"5","author":"Young","year":"2009","journal-title":"Glob Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e998","DOI":"10.1016\/S2214-109X(18)30275-4","article-title":"Prevalence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis","volume":"6","author":"Noubiap","year":"2018","journal-title":"Lancet Glob Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1093\/eurheartj\/ehq483","article-title":"Cardiovascular implications from untreated human immunodeficiency virus infection","volume":"32","author":"Baker","year":"2011","journal-title":"Eur Heart J"},{"key":"ref7","volume-title":"NCDs and HIV: How to simultaneously address needs and enhance care","year":"2018"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1164\/rccm.201406-1108OC","article-title":"Active and passive smoking and the incidence of asthma in the black Women's health study","volume":"191","author":"Coogan","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"ref9","volume-title":"Global action plan for the prevention and control of noncommunicable diseases 2013\u20132020","year":"2013"},{"key":"ref10","volume-title":"Political declaration of the high-level meeting of the general assembly on the prevention and control of Non-communicable diseases","year":"2012"},{"key":"ref11","first-page":"20","volume-title":"NCD Alliance strategic plan 2016\u20132020 from global commitments to national and regional action on NCD prevention and control","year":"2016"},{"key":"ref12","volume-title":"WHO global strategy on integrated people-centred health services 2016\u20132026. 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Placing people and communities at the Centre of health services (WHO\/HIS\/SDS\/201520)","year":"2015"},{"key":"ref13","volume-title":"Implementation tools: Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings","year":"2013"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"239","DOI":"10.2471\/BLT.18.216820","article-title":"Prevention and control of noncommunicable diseases: lessons from the HIV experience","volume":"97","author":"Abimbola","year":"2019","journal-title":"Bull World Health Organ"},{"key":"ref15","volume-title":"Integrated health services\u2014What and why","author":"Waddington","year":"2008"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e004669","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":"Adeyemi","year":"2021","journal-title":"BMJ 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