People living with HIV in low- and middle-income countries (LMICs) increasingly face comorbid noncommunicable diseases, particularly hypertension and diabetes. The concurrent management of HIV and these chronic conditions places additional demands on patients’ daily lives. This systematic review set out to describe self-care practices among people living with HIV and hypertension or diabetes comorbidities in LMICs and to identify treatment burdens associated with these practices.
The authors conducted a comprehensive search of multiple databases, including Medline, EMBASE, PsycINFO, Global Health, Scopus, Web of Science, CINAHL, WHO Global Index Medicus, African Journals Online and Google Scholar. The search targeted primary studies conducted in LMICs and published between January 2013 and March 2026, with no restrictions on study design or method of data collection. Two reviewers independently screened records, extracted data, and assessed study quality; disagreements were resolved through discussion.
Thirteen qualitative studies from six African countries met inclusion criteria and together included 458 participants. Study quality assessments rated seven studies as high quality and six as moderate quality. The review used thematic synthesis to analyze the qualitative data and mapped findings onto the Normalization Process Theory to identify treatment burdens. Confidence in the qualitative evidence was appraised using the GRADE-CERQual approach.
One primary theme identified was how participants made sense of their illnesses and the medications they were prescribed. Patients’ interpretations of symptoms, diagnoses, and the purpose of medicines influenced their self-care choices. This sense-making process shaped adherence behaviors and informed decisions about which treatments to prioritize when coping with multiple conditions.
A recurring finding was the existence of divergent treatment approaches and experiences between HIV care and care for hypertension or diabetes. Participants reported differences in the accessibility, consistency, and perceived priority of services for HIV versus noncommunicable disease management. These disparities influenced how individuals reconciled competing treatment regimens and how they organized daily self-care tasks.
The review found that many participants adopted health-promoting behaviors as part of their self-care. These included lifestyle modifications relevant to blood pressure and glycemic control, such as dietary adjustments, physical activity, and other preventive measures. Adoption of such behaviors varied and was shaped by knowledge, resources, and the broader structural context in which patients lived.
Coping with the psychosocial impact of multimorbidity emerged as a central theme. Participants described experiences of distress and emotional burden related to living with HIV and an additional chronic condition. Self-care practices included strategies for managing stress, seeking social or spiritual support, and other mechanisms to maintain psychological well-being while managing physical health demands.
Participants employed various strategies to navigate healthcare insecurities. These included pragmatic actions to manage inconsistent supply of medicines, variable quality of services, and financial or logistic barriers to care. Some strategies were patient-initiated attempts to compensate for gaps in hypertension or diabetes care, illustrating how people organized and re-prioritized tasks to maintain treatment continuity.
The authors mapped the qualitative findings onto the Normalization Process Theory to conceptualize treatment burden. Identified burdens related to prescribed healthcare tasks, disparities between HIV and hypertension/diabetes care, and additional workload from patient-initiated compensatory efforts. The mapping highlighted the cumulative demands of multimorbidity on patients’ capacity to incorporate treatment and self-management into everyday life.
The review concludes that self-care among people living with HIV and comorbid hypertension or diabetes in LMICs is diverse and heavily influenced by how individuals interpret their illnesses, structural inequities in health services, and the cumulative workload of managing multimorbidity. The authors recommend strengthening consistent education about illnesses and medications, providing psychosocial support, and delivering clearer lifestyle guidance to support equitable, integrated care and effective self-care.
They also note the need for future research to quantify self-care workload and treatment burden and to evaluate integrated care models that reduce patient workload. The review was prospectively registered in PROSPERO (CRD42023463738).
All included studies were qualitative and conducted in African LMIC settings; no quantitative estimates of self-care workload or burden were reported in the abstract. Confidence in the synthesized themes ranged from moderate to high according to the authors’ GRADE-CERQual assessments. Details such as specific country-level contexts, participant sociodemographic breakdowns, or individual study findings beyond the synthesized themes were not reported in the abstract and therefore are not summarized here.