The Patient-Provider Continuum of Care: Narratives of People Living With Comorbid HIV and Diabetes in Northern Thailand

Rhoda K Moise; Kriengkrai Srithanaviboonchai; Ali Alsolami; Mary H Soares; Bilikisu Reni Elewonibi; Marcelo E Tolmasky; Michele M Wood

doi:10.1177/2374373519882226

The Patient-Provider Continuum of Care: Narratives of People Living With Comorbid HIV and Diabetes in Northern Thailand

J Patient Exp. 2020 Oct;7(5):749-757. doi: 10.1177/2374373519882226. Epub 2019 Nov 5.

Authors

Rhoda K Moise¹, Kriengkrai Srithanaviboonchai², Ali Alsolami¹, Mary H Soares¹, Bilikisu Reni Elewonibi³, Marcelo E Tolmasky⁴, Michele M Wood⁵

Affiliations

¹ Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
² Faculty of Medicine and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
³ Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Department of Biology, California State University, Fullerton, CA, USA.
⁵ Department of Public Health, California State University, Fullerton, CA, USA.

Abstract

Background: Among South-East Asia Region countries, Thailand has a high prevalence of HIV with an increasing significant comorbidity of diabetes mellitus (DM).

Objective: Guided by syndemics, the purpose of this qualitative study is to develop insight into the experience of patients living with comorbid HIV and DM in Northern Thailand for quality improvement.

Methods: Interviews were conducted in 2 groups for content analysis: (1) people living with comorbid HIV and DM and (2) health-care staff providing care to patients living with the comorbidity.

Results: Participants' (N = 12) ages ranged from 42 to 56 (mean = 49). Health staff (N = 12) generated complementary narratives. All participants reported onset of diabetes after discovering they were HIV infected. Content analysis revealed emergent themes regarding (1) knowledge and perceptions and (2) management framed by syndemics and chronicity.

Conclusion: Findings suggest routine training for patient education and provider integration of care. Macrosocial factors such as limited access and resources and biological factor such as drug interactions are noted as key considerations for future interventions and alterations in the care for patients with comorbid HIV and DM.

Keywords: HIV; Thailand; comorbidity; diabetes; global health; patient perspectives/narratives; qualitative methods; quality improvement.