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Page 6 of 7 Original Research

neighbour, that is how I got saved. We always help each other doses to compensate for missed doses, sharing medication
that way.’ (Female, 68 years old, participant diagnosed with with others, medication rationing, the use of home remedies
HTN and DM) and traditional herbs, and the consultation of traditional or
faith healers.
Concerning home remedies, the use of ginger, garlic, cassia
abbreviata (murumanyama in local Shona language) and In this study, HTN screening was found to be integrated into
smashed avocado seeds commonly reported remedies used routine screening as part of vital measurements which should
to manage HTN. Diabetic patients often used ginger, boiled be performed at every clinic consultation regardless of HIV
black-jack and diet monitoring as remedies or alternatives for status. In principle, this is a strategic arrangement to increase
managing DM when they could not access medication: chances of hypertensive case finding as well as reducing stigma
7
‘I rely a lot on those [remedies]… especially garlic, murumanyama associated with screening only one group of patients. For DM,
[cassia abbreviata] and [smashed] avocado seeds to manage my the Zimbabwean Ministry of Health’s regulations require
[high] BP … ginger and boiled black-jack also works for sugar targeted screening where RBS measurements are taken from
[DM]… What can we do?... I can’t afford these [allopathic] patients presenting with signs and symptoms suggestive of
medicines.’ (Female, 57 years old, participant diagnosed with high blood sugar levels. While the protocols and cost of
7
HTN and DM) screening for HTN and DM could promote active case finding,
in this study, effective implementation of the process was
Patients also reported that they relied on faith and traditional threatened by non-functional equipment secondary to limited
healers for the management of HTN and DM. Most participants funds. Interrupted provision of screening services can
across all FGDs mentioned that faith and traditional healers negatively affect diagnosis of new cases and ultimately result
play an important role in managing their HTN and DM. in lower than actual incidence and prevalence rates being
Although all generally believed that allopathic medicines observed for HTN and DM, as has been found in other studies. 11
were more effective, they reported resorting to faith and
traditional healers because they were cheaper alternatives. Erratic availability of HTN and DM medication at ART sites
Participants also reported that these faith and traditional was reported as another common challenge faced by patients,
healers provided ‘spiritual-uplifting’ in the absence of medical as observed in other similar studies. 4,12,13 For the majority of
drugs: patients who could not afford medication from private
‘I know that [prescribed] drugs are effective… but one needs pharmacies, alternative approaches were taken. The reported
money to buy them. Prophets, traditional healers … and home options included medication rationing or sharing or
remedies are cheaper or even free, … so I can’t watch myself die overdose, for example, multiple doses to compensate when
when these options are there.’ (Male, 61 years old, participant the medication became available and the use of home
with DM) remedies and herbs. These options do not offer effective
treatment for HTN and DM because they are not regulated,
In some worst-case scenario, some reported avoiding formal nor is their effectiveness subjected to empirical research. If
7
healthcare for fear of what they called ‘unnecessary costs’: HTN and DM are not managed well in PLWH, the survival
‘I do not even go to the [provincial] hospital, because when I go and wellness gains of ART will be sacrificed.
there, sometimes they tell me my [blood] sugar [level] is very high
and give me bed-rest, but not the medication. The next day, they The unprecedented scale-up of ART in sub-Saharan Africa
give me a huge bill to pay for the bed-rest when I did not have (SSA) has resulted in more PLWH achieving virologic
medication. Better I rest at home.’ (Female, 48 years old, suppression and increased survival. Therefore, the
14
participant with DM) incidence of diseases associated with ageing such as HIV-
HTN, DM, chronic kidney and heart disease will also
Discussion increase. 2,14,15,16,17,18 A study conducted in Malawi revealed that
the lack of screening equipment and services, and medication
This study assessed the capacity of ART sites to manage stock-outs were frequent challenges to the care of PLWH and
HTN and DM in PLWH, from the perspectives and HTN/DM. Other studies conducted in SSA focused more
19
experiences of key healthcare workers and affected patients on the feasibility of integrating HIV/AIDS programme with
in the Gweru district of Zimbabwe. Also assessed were NCD care, and key findings point to the existence of
patients’ experiences on the challenges they face in accessing challenges in screening for HTN and DM compared to those
care and the coping mechanisms they employ in dealing for HIV/AIDS care. There is limited research into the
17
with the challenges. Several important findings emerged: (1) capacity of SSA to manage the future challenges faced by the
ART sites had limited capacity to screen for HTN and DM in long-term survivors of HIV.
PLWH, together with non-availability of HTN and DM
medication, because of limited funding available for NCDs Strengths and limitations
care; (2) PLWH who have HTN and/or DM are deterred
from accessing healthcare for HTN and DM at public ART Use of purposive sampling based on set criteria to identify
sites, mainly because of frequent unavailability of screening participants; involvement of more than one experienced
and treatment services and the high costs of medication in qualitative researcher to reduce the chances of subjective
private pharmacies; (3) coping strategies employed in bias; and attempts to attain code saturation in data collection
addressing encountered challenges include taking multiple represent methodological strengths of the study.

http://www.sajhivmed.org.za 312 Open Access