HIV/AIDS (Auckland, N.Z.) · 2026
Facilitators and Barriers to Implementation of WHO HEARTS Strategy for Hypertension and Diabetes Among People Living with HIV in Eastern Uganda: A COM-B Analysis.
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Katuramu Richard, Li Yueyun, Namugaya Maureen, Muwanga Steven Nsereko, Kibuuka Ronald, Mawejje Francis, Obakiro Samuel Baker, Kanyike Andrew Marvin, Li Zhihui
Аннотация
BACKGROUND: The World Health Organization's HEARTS technical package aims to improve the management of hypertension (HTN) and diabetes (DM) in primary health care at the population level. This study explored the barriers and facilitators of implementing this strategy among People Living with HIV (PLHIV) with Hypertension and/or Diabetes in Eastern Uganda.
METHODS: This was a descriptive qualitative study that used a semi-structured interview guide. We conducted in-depth interviews with healthcare workers (HCWs). We adopted the Capability, Opportunity, and Motivation (COM-B) model of behavior change to guide both study design and data analysis.
RESULTS: Twelve HCWs with a mean age of 36 years were interviewed. Within the capability domain, inadequate training on HTN and DM management was identified as a barrier, while existing skills in blood pressure measurement and management served as a facilitator. Social opportunity barriers included the absence of community-based support groups for integrated HIV-NCD co-management and the inability to track outcomes for patients on concurrent ART and NCD medications. Physical opportunity barriers encompassed frequent stock-outs of essential antihypertensive and antidiabetic medications, shortages of glucometer test strips and blood pressure machines, and understaffing at HIV clinics. Conversely, opportunity facilitators included collaboration with implementing partners for material support, adherence to standard treatment guidelines, and availability of lifestyle counselling sessions. Within the motivation domain, patient-centred follow-up and strong therapeutic rapport between healthcare workers and patients were identified as facilitators, with no motivational barriers reported.
CONCLUSION: Implementation of the WHO HEARTS strategy in HIV clinics is influenced by some of the COM-B domains. Building on these findings, a stakeholder-informed foundation can support the design of contextually appropriate, behaviorally targeted interventions to improve outcomes in similar settings.
METHODS: This was a descriptive qualitative study that used a semi-structured interview guide. We conducted in-depth interviews with healthcare workers (HCWs). We adopted the Capability, Opportunity, and Motivation (COM-B) model of behavior change to guide both study design and data analysis.
RESULTS: Twelve HCWs with a mean age of 36 years were interviewed. Within the capability domain, inadequate training on HTN and DM management was identified as a barrier, while existing skills in blood pressure measurement and management served as a facilitator. Social opportunity barriers included the absence of community-based support groups for integrated HIV-NCD co-management and the inability to track outcomes for patients on concurrent ART and NCD medications. Physical opportunity barriers encompassed frequent stock-outs of essential antihypertensive and antidiabetic medications, shortages of glucometer test strips and blood pressure machines, and understaffing at HIV clinics. Conversely, opportunity facilitators included collaboration with implementing partners for material support, adherence to standard treatment guidelines, and availability of lifestyle counselling sessions. Within the motivation domain, patient-centred follow-up and strong therapeutic rapport between healthcare workers and patients were identified as facilitators, with no motivational barriers reported.
CONCLUSION: Implementation of the WHO HEARTS strategy in HIV clinics is influenced by some of the COM-B domains. Building on these findings, a stakeholder-informed foundation can support the design of contextually appropriate, behaviorally targeted interventions to improve outcomes in similar settings.