---
title: "Self-care practices in people with HIV and hypertension or diabetes in LMICs: a systematic review"
id: "pubmed-42853857"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42853857"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42853857/"
doi: "10.1371/journal.pone.0360076"
published_at: "2026-10-09T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Self-care practices in people with HIV and hypertension or diabetes in LMICs: a systematic review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42853857
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42853857/)
- **DOI:** [10.1371/journal.pone.0360076](https://doi.org/10.1371%2Fjournal.pone.0360076)
- **Published At:** 2026-10-09T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review examined how people living with **HIV** and comorbid **hypertension** or **diabetes** in low- and middle-income countries (LMICs) manage these conditions through self-care, and identified related treatment burdens. - The authors searched multiple databases for primary studies from January 2013 to March 2026 and included studies conducted in LMICs regardless of design or data collection method. - Thirteen qualitative studies from six African countries were included, representing 458 participants. Study quality was judged as seven high and six moderate. - Five primary themes emerged with moderate-to-high confidence: 1) sense-making of illnesses and medications; 2) divergent treatment approaches between HIV and hypertension/diabetes; 3) adoption of health-promoting behaviors and lifestyle changes; 4) coping with psychosocial distress; and 5) strategies to navigate healthcare insecurities. - Treatment burdens identified related to prescribed healthcare tasks, disparities in care between HIV and NCD management, and patient-initiated actions to fill gaps in hypertension/diabetes care. - The authors mapped findings to the **Normalization Process Theory** to understand the workload and implementation demands of self-care and used GRADE-CERQual to assess confidence in evidence. - Conclusions emphasized that self-care practices are shaped by individuals’ interpretations of illness, structural inequities, and multimorbidity workload; recommended strengthening consistent education on illnesses and medications, psychosocial support, and lifestyle guidance to support integrated, equitable care. - The review called for future research to quantify self-care workload and treatment burden and to evaluate integrated care models that reduce patient workload. PROSPERO registration: CRD42023463738.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, LondonUnited Kingdom. * 2 MRC/ UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda. * 3 Department of Community Health and Behavioral Sciences, Makerere University, College of Health Sciences, Kampala, Uganda. * 4 Child Health and Development Centre, Makerere University, Kampala, Uganda. * PMID: **42853857** * DOI: [ 10.1371/journal.pone.0360076 ](https://doi.org/10.1371/journal.pone.0360076) Item in Clipboard # Self-care practices of people living with HIV and hypertension or diabetes comorbidities in low-and-middle income countries: A systematic review Andrew K Tusubira et al. PLoS One. 2026. Show details Display options Display options Format Abstract PubMed PMID PLoS One Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22PLoS+One%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22PLoS+One%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42853857/) . 2026 Oct 9;21(10):e0360076. doi: 10.1371/journal.pone.0360076. eCollection 2026. ### Authors [Andrew K Tusubira](https://pubmed.ncbi.nlm.nih.gov/?term=Tusubira+AK&cauthor_id=42853857)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-1 "Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, LondonUnited Kingdom.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-2 "MRC/ UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-3 "Department of Community Health and Behavioral Sciences, Makerere University, College of Health Sciences, Kampala, Uganda."), [Andrew S Ssemata](https://pubmed.ncbi.nlm.nih.gov/?term=Ssemata+AS&cauthor_id=42853857)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-1 "Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, LondonUnited Kingdom.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-2 "MRC/ UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda."), [Anne R Katahoire](https://pubmed.ncbi.nlm.nih.gov/?term=Katahoire+AR&cauthor_id=42853857)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-4 "Child Health and Development Centre, Makerere University, Kampala, Uganda."), [Carl May](https://pubmed.ncbi.nlm.nih.gov/?term=May+C&cauthor_id=42853857)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-1 "Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, LondonUnited Kingdom."), [Christine K Nalwadda](https://pubmed.ncbi.nlm.nih.gov/?term=Nalwadda+CK&cauthor_id=42853857)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-3 "Department of Community Health and Behavioral Sciences, Makerere University, College of Health Sciences, Kampala, Uganda."), [Moffat Nyirenda](https://pubmed.ncbi.nlm.nih.gov/?term=Nyirenda+M&cauthor_id=42853857)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-2 "MRC/ UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda."), [Susannah Mayhew](https://pubmed.ncbi.nlm.nih.gov/?term=Mayhew+S&cauthor_id=42853857)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42853857/#short-view-affiliation-1 "Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, LondonUnited Kingdom.") ### Affiliations * 1 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, LondonUnited Kingdom. * 2 MRC/ UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda. * 3 Department of Community Health and Behavioral Sciences, Makerere University, College of Health Sciences, Kampala, Uganda. * 4 Child Health and Development Centre, Makerere University, Kampala, Uganda. * PMID: **42853857** * DOI: [ 10.1371/journal.pone.0360076 ](https://doi.org/10.1371/journal.pone.0360076) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** 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. **Methods:** 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. **Results:** 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. **Conclusion:** Self-care practices were diverse and shaped by individuals' 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. **Systematic review registration:** PROSPERO: CRD42023463738. Copyright: © 2026 Tusubira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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