Treatment Burden and Mobile Phone Use Among Adults With Human Immunodeficiency Virus (HIV) and Type 2 Diabetes: A Qualitative Formative Study.

backgroundAdults living with both human immunodeficiency virus (HIV) and type 2 diabetes in Uganda must manage multiple chronic conditions under circumstances of constrained income, fragmented care, and variable social support. However, there is limited qualitative evidence on how treatment burden is experienced in everyday life, how mobile phones are already being used to cope with that burden, and what this implies for future intervention design.

objectiveThis study aimed to explore treatment burden among adults living with HIV and type 2 diabetes in Uganda, examine how patients informally use mobile phones and social support to manage medication and care, and identify user-informed requirements for a phone-based medication support intervention.

methodsThe study employed a qualitative design using in-depth interviews and focus group discussions (FGDs) in southwestern Uganda. Data were generated from 64 participants: 9 adults living with HIV and type 2 diabetes participated in individual in-depth interviews, and 55 participants took part in 11 FGDs. The FGDs included six patient FGDs involving 30 adults living with HIV and type 2 diabetes, four social supporter FGDs involving 20 nominated supporters, and one healthcare worker FGD involving 5 providers engaged in HIV and/or diabetes care. Qualitative data were analyzed using an inductive content analysis approach, and the emergent findings were interpreted through Burden of Treatment Theory. No participant took part in more than one data collection method.

resultsParticipants described diabetes as adding a second layer of treatment work to an already-established HIV routine. Treatment burden was shaped by medication workload and regimen complexity, fragmented healthcare pathways, financial and time pressures, and cognitive and emotional strain. Mobile phones were used to help patients and supporters manage reminders, appointments, communication, and care coordination outside the clinic setting. Social support enhanced patient capacity by buffering these burdens through reminders, accompaniment, encouragement, and practical assistance. Mobile phones were already being used informally as reminder tools, communication channels, and care coordination resources; however, their effectiveness was constrained by shared device use, privacy concerns, airtime costs, charging difficulties, and low digital confidence. Participants preferred a mobile phone-based system that was integrated across HIV and diabetes care, discreet, low-cost, compatible with feature phones, and linked to trusted human support.

conclusionMedication-taking among adults living with HIV and type 2 diabetes was experienced as part of a broader treatment burden shaped by medication routines, clinic demands, financial constraints, food insecurity, privacy concerns, and social support needs. Mobile phones were already being used informally for reminders, appointment tracking, communication, and care coordination. A phone-based medication support intervention should therefore be low-burden, privacy-sensitive, linked to trusted support, and aligned with patients' everyday phone practices.