Paving the Way for an Integrated Care Model: Experiences of Women Living With HIV and Breast Cancer in Tanzania.

Abstract

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. 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. 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. 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.