Patient and clinician preferences for diabetes management among older adults with co-morbid HIV: A qualitative exploration

PLoS One. 2024 May 14;19(5):e0303499. doi: 10.1371/journal.pone.0303499. eCollection 2024.

Abstract

Background: Older adults with HIV are at increased risk of developing certain chronic health conditions including type 2 diabetes mellitus (T2DM). As the number and complexity of conditions increases, so do treatment and health care needs. We explored patient and clinician preferences for HIV+T2DM care and perceived solutions to improving care.

Methods: We conducted an exploratory qualitative study comprised of individual in-depth interviews. Participants included English-speaking patients aged 50 and older living with HIV and T2DM and infectious disease (ID) and primary care (PC) clinicians from a large academic health center in Chicago. Thematic analysis drew from the Framework Method.

Results: A total of 19 patient and 10 clinician participants were interviewed. Many patients reported seeking HIV and T2DM care from the same clinician; they valued rapport and a 'one-stop-shop'. Others reported having separate clinicians; they valued perceived expertise and specialty care. Nearly all clinicians reported comfort screening for T2DM and initiating first line oral therapy; ID clinicians reported placing referrals for newer, complex therapies. Patients would like educational support for T2DM management; clinicians would like to learn more about newer therapies and easier referral processes.

Conclusions: Patient-centered care includes managing T2DM from a variety of clinical settings for individuals with HIV, yet strategies are needed to better support clinicians. Future research should examine how best to implement these strategies.

MeSH terms

  • Aged
  • Chicago / epidemiology
  • Comorbidity
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / epidemiology
  • Diabetes Mellitus, Type 2* / psychology
  • Diabetes Mellitus, Type 2* / therapy
  • Disease Management
  • Female
  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • HIV Infections* / psychology
  • HIV Infections* / therapy
  • Humans
  • Male
  • Middle Aged
  • Patient Preference* / psychology
  • Qualitative Research*

Grants and funding

This work was supported by funding from the Chicago Center for Diabetes Translation Research, (NIDDK P30 DK092949), Deans’ offices of the Biological Sciences Division of the University of Chicago and Feinberg School of Medicine at Northwestern University. The work was also funded in part, by the National Institutes of Health's National Institute on Aging, Grant Number P30AG059988. REDCap software is supported by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The opinions expressed in this paper are those of the authors and do not necessarily represent National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.