article · JCO Global Oncology
Breast cancer is a leading cancer diagnosis globally, and its effects are exacerbated in sub-Saharan Africa due to high HIV rates. In Tanzania, women living with both HIV and breast cancer frequently present with advanced cancer despite regularly attending HIV treatment clinics. A qualitative study examined the experiences of eleven patients and ten healthcare providers, including oncologists and infectious disease specialists, to understand the obstacles and enablers regarding integrated care. The findings reveal that patients encounter significant challenges such as stigma, financial and logistical constraints, fragmented health services, and delays caused by reliance on spiritual healing. Conversely, trust in medical providers, peer support, psychosocial counselling, and colocated clinics emerged as key facilitators. Addressing these issues requires multidisciplinary, patient-centred care alongside broader community collaboration with faith-based bodies and government ministries to improve education and service delivery.
When patients must manage two severe health conditions simultaneously, fragmented medical services and social stigma can lead to fatal delays in treatment. Understanding the daily challenges of women navigating both HIV and breast cancer allows health systems to design joined-up, empathetic services. This research provides evidence needed to restructure clinic visits, train staff, and engage community partners to catch cancer earlier and improve survival rates.
The abstract does not indicate an application pathway, as it focuses on qualitative health systems research and care delivery models rather than a commercial product or service.
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PURPOSE: Breast cancer (BC) is the most frequently diagnosed cancer among women globally. In sub-Saharan Africa, its impact is compounded by high HIV prevalence. Studies show that women living with HIV and BC (WLHIVBC) often present at advanced stages despite contact with HIV Care and Treatment Clinics. Little is known about their experiences in navigating both conditions. This study explored barriers and facilitators to integrated care for WLHIVBC in Tanzania to inform development of a patient-centered care model. METHODS: This qualitative study used a grounded theory approach, conducting 21 in-depth interviews with 11 WLHIVBC and 10 health care providers (oncologists, infectious-disease specialists, nurses, and pharmacists) over 10 months. Analysis followed an iterative coding process using Dedoose, and a multidisciplinary team refined key themes shaping the proposed integrated care model. RESULTS: Participants described barriers including stigma, nondisclosure, logistical and financial constraints, fragmented services, psychological burden, and reliance on spiritual healing. Facilitators included trust in providers, colocated services, patient education, peer support, and psychosocial counseling. Faith played a dual role-strengthening some while delaying care for others. Participants identified faith-based organizations as partners in education and stigma reduction. Recommendations emphasized colocated clinics, empathetic communication, psychosocial support, and collaboration with the Ministry of Health, Ministry of Education, and faith-based organizations to strengthen community education and linkage to care. CONCLUSION: WLHIVBC in Tanzania face intersecting burdens of stigma, late presentation, and fragmented services. Yet, trust, peer networks, and education provide clear entry points for integration. Findings call for holistic, patient-centered, multisectoral approaches bridging oncology and HIV care and prioritizing patient experience.
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DOI: 10.1200/go-25-00330
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