Non-communicable disease care for persons living with HIV in Peru: A national physician cross-sectional study

Non-communicable diseases (NCDs) are a significant cause of morbidity and mortality for the aging HIV population worldwide. In Peru, no data exists on how providers address NCDs for persons living with HIV (PLWH). This study examines HIV physician confidence and current management practices for NCDs for PLWH in Peru. We recruited public-sector HIV physicians via Peru's National HIV, STI and Hepatitis Program's (NHSTIHP) physician registry and by program coordinator referral. Participants completed a telephone survey encompassing seven NCDs [hyperlipidemia, hypertension, diabetes, osteoporosis, sarcopenia, non-AIDS defining cancers, neurocognitive impairment (NCI)] and three modifiable risk factors (obesity, tobacco, and alcohol use). Survey domains included: (1) provider and practice characteristics (2) NCDs encountered, (3) provider confidence in prevention, diagnosis, and treatment (based upon a four-point Likert scale), (4) screening frequency and management approaches (free response). We obtained contact information from 167 physicians working with the NHSTIHP, and 78 (47%) volunteered to participate (mean age 45.8 ± 9.3 years; 26% women; 78% infectious disease trained) across 23 of the 25 regions of Peru. The majority (>50%) of physicians reported at least one patient with: hyperlipidemia, hypertension, diabetes, NCI, cervical cancer, obesity, tobacco, and/or alcohol use. Physicians felt most confident independently managing metabolic disorders (hyperlipidemia, diabetes, hypertension, obesity), and least confident with NCI and sarcopenia. Most physicians (>50%) would manage the NCDs, although management approaches differed. NCD screening that was part of the NHSTIHP National HIV care guidelines was more consistently performed than screening beyond the scope of the existing guidelines. Peruvian HIV physicians encounter NCDs in their patient population and manage these conditions and risk factors despite variable confidence and/or knowledge of best practices. This study highlights opportunities for expanding physician education, addressing systems-level barriers to NCD care, and the need for locally relevant, epidemiologically-based, HIV-specific NCD care guidelines.