Evaluation of the relevance, acceptability, and adaptability of an existing healthy lifestyle program for people living with HIV

Abstract Introduction Dolutegravir-based antiretroviral therapy (ART), a key component of HIV treatment in low- and middle-income countries, has been associated with weight gain and increased adiposity in people living with HIV (PLWH). This weight gain, along with fat redistribution, can elevate the risk of diabetes, hypertension, and cardiovascular disease. The South African Diabetes Prevention Program (SA-DPP) is a culturally tailored lifestyle intervention addressing nutrition, physical activity, and other risky behaviors, developed for resource-limited communities. We sought to evaluate the clinical experiences of PLWH and the acceptability and suitability of the SA-DPP intervention for this population. Methods A qualitative study was conducted with PLWH and health staff from three primary health clinics in Cape Town (n = 35), selected through purposive sampling. The research included five focus groups and two individual interviews with PLWH, as well as five interviews (with healthcare staff (doctors, nurses (paired interview), and lay counselors; n = 6,). The discussions explored experiences regarding HIV treatment, lifestyle challenges, education, and support from clinics, and collected perspectives on the SA-DPP materials. All sessions were transcribed and thematically analyzed for insights into feasibility and acceptability. Results The SA-DPP curriculum was well received by both PLWH and healthcare staff, who found the content and structure comprehensive and relevant to nutrition and exercise needs. Participants valued the practicality of the booklets, with experts noting that the information and suggested activities were accessible in terms of cost and availability. Both groups indicated the material supported healthy behavior changes, though some experts suggested further adaptation to address unique challenges faced by PLWH, such as stigma and cultural perceptions of body image. Conclusion The SA-DPP intervention was considered acceptable and relevant for addressing key lifestyle issues among PLWH. It has potential as a resource for managing various lifestyle-related diseases in this population, though further adaptation may be needed to enhance its relevance and address specific barriers in the context of HIV care.