Knowledge, Attitudes, Perceptions, and Practices towards Cardiovascular Disease Risk Prevention and Management in Patients Living with HIV in Sub-Saharan Africa: A Qualitative Systematic Review

Abstract

Background: Cardiovascular diseases (CVD) are projected to bypass HIV as the most common cause of death in sub-Saharan Africa (SSA) by the year 2030. People living with HIV (PLHIV) are more likely to develop and suffer from complications of CVD compared to their HIV negative counterparts. CVD prevention is therefore critical in this group to maintain positive health outcomes and improve health indices in the entire region. To achieve this, it is important to assess patients’ understanding of CVD risks and explore their perceptions and practices, to design targeted interventions. This review was therefore performed to synthesise the best available qualitative evidence of the knowledge, attitudes, perceptions, and practices of CVD risk prevention and management from the perspective of PLHIV.

Methods: Three electronic databases (MEDLINE, CINAHL, PUBMED) were searched for references up to August 2021. Six records from Malawi, Kenya, and South Africa were retrieved and synthesised through a thematic analysis approach. PLHIV in most of the studies had poor knowledge and perceptions about CVD risks.

Results: Analysed data were categorised under two broad themes, namely, knowledge and perceptions, and attitudes and practices. Psychological factors such as stress and denial of HIV status and behavioural factors such as poor diet, physical inactivity, and taking antiretrovirals (ARVs) were often cited as the cause of CVDs. Patients were aware of the dangers of CVDs such as sudden death, vision loss, and heart attacks but had varied attitudes and practices towards its prevention. Financial hardship, unavailability of medication, and hearsay were the main factors that prevented adoption and adherence to both lifestyle measures and medical treatment. Conversely, social, community, family, and peer support, as well as the fear of developing life-threatening complications, motivated some PLHIV to adopt health-seeking behaviours and medical management.

Conclusions: These findings highlight the need for improved patient education and multi-morbid health promotion. It also stresses the need for health policy reforms, and an integrated approach to HIV and CVD treatment and care in SSA.