Abstract
BackgroundLittle is known about how people living with human immunodeficiency virus (HIV) experience malaria and the concomitant use of anti-malarial treatments with anti-retrovirals (ARVs). An understanding of how patients make sense of these experiences is important to consider in planning and supporting the clinical management and treatment for co-infected individuals.MethodsA qualitative study was conducted in Tanzania alongside a clinical trial of concomitant treatment for HIV and malaria co-infection. Focus group discussions were held with people receiving treatment for HIV and/or malaria, and in-depth interviews with health workers responsible for HIV care and members of the clinical trial team. Data were analysed inductively to identify themes and develop theoretical narratives.ResultsResults suggest that people living with HIV perceived malaria to be more harmful to them due to their compromised immune status but saw the disease as unavoidable. For those enrolled in the clinical controlled study, taking anti-malarials together with ARVs was largely seen as unproblematic, with health workers’ advice and endorsement of concomitant drug taking influential in reported adherence. However, perceptions of drug strength appeared to compel some people not enrolled in the clinical study to take the drugs at separate times to avoid anticipated harm to the body.ConclusionsManagement of HIV and malaria concurrently often requires individuals to cross the domains of different disease programmes. In the context of a trial concerned with both diseases, patients experienced the support of clinicians in guiding and reassuring them about when and how to take drugs concomitantly. This points towards the need to continue to strive for integrated care for patients with HIV.
Highlights
Little is known about how people living with human immunodeficiency virus (HIV) experience malaria and the concomitant use of anti-malarial treatments with anti-retrovirals (ARVs)
The qualitative study was conducted in 2011 alongside a clinical controlled study which assessed the therapeutic efficacy, clinical safety and pharmacokinetic interactions of anti-malarials taken concomitantly with anti-retrovirals in adults co-infected with HIV and uncomplicated malaria, against comparator groups of HIV-positive adults co-infected with malaria but not taking anti-retrovirals, and HIV-negative adults with malaria between 2009 and 2012
While the harmful effect of HIV co-infection on malaria incidence and disease severity is well documented in the academic literature, including more frequent and more severe malaria illness episodes [36], we found that people living with HIV saw malaria as unavoidable, even ‘normal’
Summary
Little is known about how people living with human immunodeficiency virus (HIV) experience malaria and the concomitant use of anti-malarial treatments with anti-retrovirals (ARVs). An understanding of how patients make sense of these experiences is important to consider in planning and supporting the clinical management and treatment for co-infected individuals. The global burdens of malaria and human immunodeficiency virus (HIV) are high, together causing over 2.5 million deaths in 2009 [1,2]. In many sub-Saharan African countries, including Tanzania, populations are at risk of HIV and malaria concurrently. Investment in supply of effective anti-malarials and anti-retrovirals (ARVs) has been significant [6], and there is an increasing knowledge about the potential therapeutic implications of treating co-infected individuals. Recent studies suggest that drug-drug interactions between certain anti-malarials and anti-retrovials exist, which affects achieved drug concentrations and may influence the efficacy and/or the safety profiles of those treatments, depending on the medicine combination [7,8,9]
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