Addressing Barriers to Achieving Treatment Goals for Cardiometabolic Disorders for Persons Living with HIV in the Southeastern United States

Abstract

Background: People living with HIV (PLWH) in the United States, particularly in the Southeast, carry a disproportionate burden of cardiometabolic disorders including hypertension, type 2 diabetes, and dyslipidemia. Despite the transformative impact of antiretroviral therapy (ART) in extending life expectancy, PLWH face a 50% greater risk of myocardial infarction and substantially elevated cardiovascular mortality compared to the general population. Patient activation–an individual’s knowledge, skills, and confidence to manage their own health–offers a promising but underexplored framework for improving cardiometabolic self-management in this population.Methods: This study presents a secondary qualitative analysis of in-depth interviews (IDIs) conducted as part of a mixed-methods study (NCT05129345) examining patient activation and cardiometabolic self-management among PLWH across five clinical and community-based sites in North Carolina. Nineteen participants aged 35 years or older with at least one diagnosed cardiometabolic condition were included. Interview data were analyzed using thematic analysis guided by the Patient Activation Measure (PAM) framework to identify barriers and facilitators to self-management. Results: Five interrelated themes emerged: (1) understanding of provider recommendations; (2) ease or difficulty of integrating recommendations into daily routines; (3) confidence in communicating with providers; (4) adherence to recommendations over time; and (5) motivating factors for adherence. While many participants demonstrated strong motivation and relational trust with providers, structural barriers–including financial constraints, transportation challenges, medication side effects, and competing social demands–were the most prominent obstacles to sustained self-management. Provider communication clarity and alignment of recommendations with existing routines were key facilitators. Conclusions: Improving cardiometabolic outcomes among PLWH in the Southeastern United States requires interventions that address structural and social determinants of health alongside patient education. Integrating patient activation frameworks such as the PAM into routine HIV care can help identify individuals requiring targeted support and guide the development of equitable, patient-centered strategies for long-term cardiometabolic health.