I am planning to conduct a qualitative, implementation-focused study to identify key facilitators and barriers to integrating basic kidney disease screening and management into HIV care clinics in northern Tanzania. While antiretroviral therapy has improved survival among people living with HIV (PWH), it has also shifted the burden toward chronic conditions such as chronic kidney disease (CKD), which remains underdiagnosed and undertreated in resource-limited settings. HIV clinics provide an important opportunity to address this gap, but successful integration requires understanding local clinical, structural, and patient-level factors.
I will conduct in-depth interviews with key stakeholders, including PWH over age 40, HIV care providers, nephrologists, and health system leaders across several care and treatment clinics. Guided by the Consolidated Framework for Implementation Research (CFIR), the study will explore multilevel influences on implementation, including provider knowledge and confidence, clinic workflows, laboratory capacity, referral systems, and patient perspectives on kidney disease. Interviews will be conducted with local research partners and analyzed using rigorous qualitative methods to generate actionable insights.
This project will make a difference by informing the design of a feasible, contextually appropriate strategy to integrate CKD screening and early management into routine HIV care. By leveraging existing infrastructure, this work aims to promote earlier detection of kidney disease, reduce progression to advanced CKD, and improve long-term outcomes for PWH. More broadly, it contributes to scalable models for integrating non-communicable disease care into HIV programs in resource-limited settings, strengthening comprehensive and sustainable health systems.
This project will primarily benefit people living with HIV (PWH) in northern Tanzania, particularly adults over age 40 receiving care through HIV Care and Treatment Clinics (CTCs). This population is at increased risk for chronic kidney disease (CKD) due to the combined effects of HIV-associated nephropathy, chronic inflammation, comorbid conditions, and potential antiretroviral-related nephrotoxicity. Despite this elevated risk, CKD often remains underdiagnosed until advanced stages, when treatment options are limited and outcomes are poor.
This population was selected because Tanzania has a high burden of HIV and a growing burden of non-communicable diseases, yet access to nephrology services and dialysis remains limited. As a result, PWH in this setting face disproportionate morbidity and mortality from preventable and treatable kidney disease. Additionally, many patients are already engaged in longitudinal HIV care through established clinic systems, creating a unique opportunity to integrate kidney disease screening and early management into existing care structures.
The project will also benefit healthcare providers and health systems by identifying practical strategies to support the integration of CKD care into routine HIV services. By focusing on a high-risk population within an existing care platform, this work aims to improve early detection, guide timely management, and ultimately reduce the burden of advanced kidney disease in a setting where treatment options are constrained.
This project will generate critical, context-specific insights into how basic kidney disease screening and management can be effectively integrated into HIV care in northern Tanzania. By identifying multilevel facilitators and barriers across patients, providers, and health systems, the study will directly inform the development of a feasible, locally tailored implementation strategy to improve early detection and management of chronic kidney disease (CKD) among people living with HIV (PWH). In the near term, this work will support more timely recognition of CKD risk, improved clinical decision-making, and more coordinated referral pathways, with the goal of reducing progression to advanced disease in a resource-limited setting.
Beyond the immediate setting, the findings will contribute to a broader understanding of how non-communicable disease care can be integrated into established HIV care platforms. This has implications for other regions facing similar dual burdens of HIV and chronic disease, supporting more comprehensive and sustainable models of care.
The learnings from this experience will directly inform my future work in global health and implementation science. I will disseminate findings through abstracts and manuscripts and continue collaboration with Tanzanian partners to refine and pilot an intervention based on these results. Additionally, the skills gained in qualitative research, cross-cultural collaboration, and implementation frameworks will strengthen my ability to design and evaluate scalable interventions in resource-limited settings. These experiences will shape my long-term goal of advancing integrated care models that address both infectious and chronic diseases in underserved populations.
People were at the center of my trip to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania, these include research collaborators at KCMC, patients, and multiple providers.
I conducted a qualitative study exploring how basic kidney care could be integrated into HIV Care and Treatment Centres (CTCs) in northern Tanzania. The goal is to help shape care around the experiences, priorities, and resources of the people who would use and deliver these services.
Our study focused on patients receiving HIV care at Majengo, Pasua, and St. Joseph’s, 3 HIV CTCs and bringing together perspectives across different stages of kidney health: people without known kidney disease, those with reduced kidney function who were not receiving kidney care, those receiving care for chronic kidney disease, and those requiring dialysis. Including this range of experiences allowed us to explore both what earlier screening might mean to patients and what happens when someone must navigate more advanced kidney care.
The patient interviews explored the human consequences of managing these conditions together: understanding a kidney disease diagnosis, accessing testing and medications, navigating referrals, paying for transportation and care, and balancing appointments with work and family responsibilities. We also asked whether patients would find kidney screening and basic management acceptable within the HIV clinics where they already receive care. Their participation creates an opportunity for their experiences and preferences to inform the design of future services.
Patients’ families and caregivers are also potential beneficiaries of this work. The demands of chronic illness can extend throughout a household, affecting finances, caregiving responsibilities, and time available for work or education. If future integration makes kidney care easier to access and reduces the need for separate visits, it could help lessen these burdens. Earlier recognition and management of kidney disease could also help patients preserve their health and independence. These are longer-term goals that this research is intended to support.
The HIV providers and nephrologists we interviewed are another central group affected by the project. HIV clinicians would be responsible for incorporating additional screening, counseling, and management into their existing work. Their perspectives were therefore essential to understanding what is feasible, including the training, staffing, laboratory access, medications, and referral support that integration would require. Nephrologists contribute a complementary perspective on which aspects of kidney care can be delivered in HIV clinics and when specialist evaluation is needed. Bringing these perspectives together can inform a model that supports clinicians while responding to patients’ needs.
I am grateful to my Tanzanian research colleagues and partner institutions, who are central to both the work and its potential impact. Their knowledge of local clinical practice, language, and health-system realities grounds the study in the setting it is intended to serve. This project contributes to an ongoing collaboration between Duke and KCMC, with the intention that the findings will help local partners identify priorities and guide the development of a feasible, acceptable approach to integrated care.
The immediate contribution of my trip was to gather patient and provider perspectives to inform that next stage. The study has not yet implemented an integrated-care intervention or demonstrated improved clinical outcomes. Its value lies in establishing the groundwork for future services that reflect what patients need and what local clinicians can sustainably provide. Ultimately, I hope this work will help people living with HIV access basic kidney care through familiar clinical relationships, with fewer obstacles between identifying a problem and receiving appropriate care.
