Table 2 Characteristics of the studies

Abele [17] (2018), US

Phenomenological study (in-depth interviews)

To explore the experience of PLWH aged over 50 living with HIV and comorbidities.

Participants: 10 PLWH aged over 50;

Mean age: 60.5 yrs.;

Male: 80%;

Comorbidities: at least 1 type of comorbidity;

Race: not specific;

Participants were recruited from an HIV agency in the US and an online HIV community.

Three themes were identified: 1) from fear of the unknown to ownership; 2) from ownership to survival; and 3) the constant struggle of surviving with HIV.

Bosire et al. [18] (2020), South Africa

Case study (narrative interviews)

To explore how women address multiple chronic and infectious diseases.

Participants: 3 women PLWH;

Age: 30–45 yrs.;

Male: 0%;

Race: Black;

Comorbidities: two participants living with breast cancer, hypertension, and HIV;

Patients were recruited from a cancer study in South Africa.

One theme was identified in PLWH: social and economics of family.

Bosire [21] (2020), South Africa

Ethnographic study (narrative interviews)

To describe the experiences of PLWH seeking care for comorbid HIV and diabetes in a hospital in South Africa.

Participants: 15 PLWH;

Age: 40–70 yrs.;

Male: 46.6%;

Race: Black;

Comorbidity: Type 2 diabetes;

Economic status: more than half of PLWH were unemployed with $60.72–$121.45 income per month;

Participants were recruited from one diabetes clinic at a tertiary hospital in South Africa.

Two themes were identified: 1) patients’ experiences accessing chronic care and 2) patients’ experiences of self-management at home.

Corrigan et al. [22] (2020), US

Descriptive study (semistructured interviews)

To explore the perception of cancer care experience among PLWH.

Participants: 27 PLWH;

Median age: 56 yrs.;

Male: 81.5%;

Race: 70.4% were African American, 25.9% were Caucasian, and 3.7% were Hispanic/Latino;

Comorbidity: cancer;

Economic status: median annual household income was $24,000;

Participants at different stages in the cancer care process were recruited by using DEDUCE software and electronic medical records.

Eight types of barriers to care were identified: 1) side effects from treatment; 2) stigma; 3) accessibility issues; 4) financial burden of cancer treatment; 5) emotional and mental health difficulties; 6) family or personal issues; 7) mistrust in providers; and 8) fear of cancer diagnosis and treatments.

Gonah et al. [23] (2020), South Africa

Descriptive study (key informant interviews and focus group discussions)

To identify the challenges and ways of coping of PLWH with comorbid hypertension and diabetes mellitus accessing care.

Participants: 8 health managers and 72 PLWH;

Age: 50% aged 30–49 yrs. and 50% aged > 50 yrs.;

Male: 33.3%;

Comorbidities: hypertension and/or diabetes mellitus);

All participants were recruited from six ART sites in South Africa.

Three themes were identified: 1) management of hypertension and diabetes mellitus; 2) capacity to screen hypertension and diabetes mellitus; and 3) capacity to treat hypertension and diabetes mellitus.

Hing et al. [24] (2019), Malawi

Phenomenological study (semistructured interviews)

To explore the experience and perception of HIV and hypertension among PLWH.

Participants: 75 PLWH;

Median age: 53 yrs.;

Male: 36%;

Comorbidity: hypertension;

Participants were recruited from an HIV treatment site in Malawi.

Six themes were identified: 1) perceived susceptibility to comorbidities; 2) perceived severity of comorbidities; 3) perceived benefits of controlling comorbidities; 4) perceived barriers to controlling comorbidities; 5) perceived self-efficacy in controlling comorbidities; and 6) cues to action for controlling comorbidities.

Mendenhall et al. [25] (2019), South Africa

Phenomenological study (narrative interviews)

To explore how Black South Africans perceive and experience multiple concurrent medical conditions.

Participants: 80 participants with multimorbidities;

Mean age: 56 yrs.;

Male: 37.5%;

Economic status: median monthly income was $196;

Comorbidities: various types of comorbidities, including hypertension, HIV, obesity, diabetes, tuberculosis, arthritis, chronic pain, depression, and anxiety;

Participants were recruited from two hospitals in South Africa.

Five themes regarding HIV and comorbidities were identified: 1) complexity of multimorbidities; 2) defining sickness and health; 3) understanding cancer; 4) differentiating between conditions; and 5) managing multiple conditions.

Monroe et al. [26] (2013), US

Phenomenological study (focus group)

To explore perspectives of living with HIV and diabetes mellitus or hypertension among PLWH and the factors affecting their medication adherence.

Participants: 35 PLWH;

Mean age: 51 yrs.;

Male: 54%;

Race: Black 94%;

Comorbidity: diabetes or hypertension;

Participants were recruited through self-referrals from flyers and through referrals from medical providers in one HIV clinic in the US.

Four themes were identified: 1) comorbidities generate concern and frustration; 2) understanding health conditions and medications promotes adherence; 3) simpler regimens with fewer side effects promote adherence; and 4) untreated substance abuse and mental health issues hinder adherence.

Morgan et al. [27] (2018), Ghana

Phenomenological study (semistructured interviews)

To explore the perceptions and experiences of women living with multimorbidity in Ghana.

Participants: 20 women participants with multimorbidity

Mean age: 56 yrs.;

Male: 0%;

Economic status: 60% were employed;

Comorbidity: HIV was the most common condition among the participants;

Participants were recruited from three polyclinics in Ghana.

Four themes emerged: 1) the influences on patients’ health experience; 2) seeking care and the responsiveness of the health care system; 3) how patients manage health care demands; and 4) outcomes due to health.

Muiruri et al. [28] (2020), US

Descriptive study (semistructured interviews and focus group discussion)

To identify the factors associated with adherence to cardiovascular disease (CVD) medications among PLWH with viral suppression.

Participants: 51 PLWH taking ART and CVD medications

Mean age: 57 yrs.;

Male: 66.7%;

Race: Africa American 60.8%;

Economic status: Monthly income $983;

Participants were recruited from three hospitals in the US.

Three main themes were identified: 1) CVD prevention preferences and practices; 2) impact of long-term HIV care on adherence to CVD medication; and 3) factors motivating the adoption of and adherence to heart healthy behaviors

Peer et al. [29] (2020), South Africa

Mix-methods study (focus group and in-depth and semistructured interviews)

To explore the perceptions and experiences of PLWH with hypertension and identify their healthcare providers’ experiences interacting with patients with multiple comorbidities in South Africa.

Participants: 55 PLWH, 11 clinicians, 10 specialized nursing professionals, and 12 lay counselors;

Comorbidity: hypertension;

Participants were recruited from 17 public healthcare facilities in South Africa.

Four themes were revealed: 1) patient resources and priorities for HIV management; 2) clinical resources and priorities for HIV management; 3) patient resources and priorities for comorbid NCD management; and 4) clinical resources and priorities for comorbid NCD management.

Simonik et al. [30] (2016), Canada

Descriptive study (semistructured interviews)

To explore readiness to engage in exercise among PLWH with multimorbidity.

Participants: 14 PLWH (HIV and other morbidities);

Median age: 50 yrs.;

Male: 64.3%;

Race: Caucasian 35.7%, Aboriginal/first nation 14.3%, other 21.4%, and not identified 28.6%;

Comorbidities: asthma, cancer, eye disorder, hepatitis C, mental health conditions, muscle pain, joint pain, hypertension, peripheral neuropathy, arrhythmia, and neurocognitive decline;

Participants were recruited from a specialty hospital in Canada.

Readiness was influenced by 1) physical impairments; 2) mental health challenges; and 3) uncertainty due to HIV and concurrent health conditions.

Subfactors that influenced readiness to exercise included 1) social support; 2) perceptions and beliefs; 3) past experience with exercise; and 4) accessibility.

Slomka et al. [31] (2017), US

Phenomenological study (focus group interviews)

To explore the lived experiences of multimorbidity among PLWH.

Participants: 22 PLWH with at least one other chronic condition;

Mean age: 51 yrs.;

Male: 73%;

Race: Africa American 81.8%;

Comorbidities: hypertension, heart disease, heart failure, kidney disease, hepatitis C, liver disease, mental health conditions, diabetes;

Participants were recruited from a large specialty HIV clinic in the US.

Four themes were identified: 1) HIV as a background for other chronic conditions; 2) managing medications and provider interactions; 3) coping with future health care needs; and 4) stigmatized social environment of multimorbidity with HIV.

Warren-Jeanpiere et al. [32] (2014), US

Phenomenological study (focus group interview)

To explore how the age, identity, comorbidities, social responsibilities, and relationship status of older HIV-positive African American women influence their HIV self-management.

Participants: 23 PLWH;

Mean age: 57 yrs.;

Male: 0%;

Race: Africa American 100%;

Comorbidities: arthritis, high blood pressure, hepatitis, cancer, depression, heart disease, diabetes;

Participants were recruited from one hospital in the US.

Four themes were identified: 1) “Taking it one day at a time”; 2) “Age ain’t nothing but a number”; 3) “Forget the single life”; and 4) “Daily life struggles”.