Explo ing he expe iences and pe spec i es o
I aqi heal hca e p o ide s on he challenges
and de e minan s o HIV managemen : a
quali a i e s udy
Shlo a Najim Talabani1,2, Ehab Mudhe Mikhael2
1 Nase Hospi al, Di ec o a e o Heal h - Ki kuk, I aqi Minis y o Heal h, Ki kuk, I aq
2 Clinical Pha macy Depa men , College o Pha macy, Uni e si y o Baghdad, Baghdad, I aq
Co esponding au ho :
Ehab Mudhe Mikhael (ihab[email p o ec ed]u.iq)
Recei ed
29 June 2025♦
Accep ed
14 Sep embe 2025♦
Published
10 Oc obe 2025
Ci a ion:
Talabani SN, Mikhael EM (2025) Explo ing he expe iences and pe spec i es o I aqi heal hca e p o ide s on he chal-
lenges and de e minan s o HIV managemen : a quali a i e s udy. Pha macia 72: 1–15. h ps://doi.o g/10.3897/pha macia.72.e163561
Abs ac
A Physician non-adhe ence o guidelines and esou ce cons ain s hinde op imal HIV ca e and pa ien ou comes; howe e , li le is
known abou p o ide s’ expe iences in I aq. This quali a i e s udy explo ed physicians’ p ac ices, challenges, and sugges ions o im-
p o ing HIV managemen ac oss h ee I aqi HIV cen e s. F om Feb ua y o Ap il 2025, we conduc ed semi-s uc u ed ace- o- ace
in e iews in A abic wi h 17 physicians (minimum six mon hs o expe ience in managing HIV pa ien s), using an expe - alida ed
guide. Thema ic analysis iden i ied ou hemes: clinical managemen o HIV pa ien s, heal hca e p o essionals’ oles, pa ien adhe -
ence o an i-HIV he apy, and heal hca e se ices o HIV pa ien s. Mos physicians epo ed ollowing I aqi Minis y o Heal h and
WHO p o ocols, wi h eno o i –lami udine–dolu eg a i (TLD) a o ed as i s -line he apy o i s e icacy and ole abili y. Majo
ba ie s o pa ien adhe ence included s igma, shame, low heal h li e acy, misconcep ions, and ollow-up challenges. Al hough p o-
ide s deemed exis ing se ices sa is ac o y, hey ecommended es ablishing specialized den al, su gical, and psychia ic clinics, and
expanding pa ien educa ion, psychosocial suppo , and engagemen o enhance comp ehensi e ca e. In conclusion, cu en HIV
ea men align wi h in e na ional s anda ds; meanwhile add essing sociocul u al ba ie s and esou ce gaps h ough suppo i e
se ices may imp o e adhe ence and heal h ou comes o people li ing wi h HIV in I aq.
Keywo ds
heal h pe sonnel, HIV in ec ions, quali a i e, social s igma, ea men adhe ence and compliance
In oduc ion
The human immunode iciency i us (HIV) is a e o i-
us ha a ge s he human immune sys em, speci ical-
ly Clus e o Di e en ia ion 4-posi i e (CD4+) T lym-
phocy es, leading o p og essi e immune supp ession
(Masenga e al. 2023), which can inc ease he isk o
de eloping in ec ions and, consequen ly, mo bidi y and
mo ali y (Pya ali e al. 2020). In I aq, a coun y wi h a
popula ion o o e 47 million, an annual g ow h a e o
2.1%, and a median age o 20.8 yea s – making i he 34 h
mos populous coun y in he wo ld – HIV p e alence is
ela i ely low. Recen da a om he Wo ld Bank, WHO,
and he I aqi Minis y o Heal h indica e ha he p e a-
lence o HIV among indi iduals aged 15–49 emains a
0.1% (UN 2024).
Copy igh Talabani SN & Mikhael EM. This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A i-
bu ion License (CC-BY 4.0), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal
au ho and sou ce a e c edi ed.
Pha macia 72: 1–15
DOI 10.3897/pha macia.72.e163561
Resea ch A icle
Talabani SN & Mikhael EM: Quali a i e insigh s in o HIV managemen in I aq2
This a e is among he lowes bo h egionally and glob-
ally, despi e an inc ease in he o al numbe o epo ed
cases. The 2024 epo om I aq’s Pa liamen a y Heal h
and En i onmen Commi ee con i ms ha a o al o 2,638
HIV/AIDS cases ha e been eco ded since he s a o he
pandemic, wi h 470 dea hs du ing his pe iod. While hese
numbe s migh seem small a i s , he annual g ow h a e
o new HIV in ec ions was 14.7% in 2019, showing a sig-
ni ican ise in ecen yea s (WHO 2018; UNAIDS 2025).
Addi ionally, i is wo h no ing ha mos new cases occu
in males (o e 83%), wi h an a e age age o 36.8 yea s o
ecen ly iden i ied indi iduals, anging om 16 o 68 yea s
old. Mos newly egis e ed cases a e concen a ed among
people unde 45 yea s old (Talabani and Mikhael 2025).
Since 1986, he HIV ansmission pa e n has e ol ed no-
ably. Ini ially, app oxima ely 66% o ea ly cases we e linked
o hemophiliacs who ecei ed con amina ed blood p od-
uc s, ma king he i s documen ed ou b eak. Mo e ecen -
ly, he e osexual con ac has become he dominan mode o
ansmission, inc easing om 17% in 2012 o o e 60–70%
in ecen s udies. Ve ical ansmission, o mo he - o-child
sp ead, has his o ically accoun ed o 5% o cases bu e-
mains a e oday due o imp o ed blood sc eening and an e-
na al in e en ions. O he modes, such as in a enous d ug
use and homosexual ansmission, a e likely unde epo ed
o no ully cap u ed in o icial eco ds, hough conce ns
abou unde -de ec ion pe sis , especially wi hin key pop-
ula ions. Addi ionally, eme ging isks include exposu e in
unlicensed beau y salons and a oo pa lo s and he impac s
o inc eased in e na ional a el, highligh ing he shi ing
and expanding landscape o HIV ansmission ou es (Si-
monsen e al. 1999; De Cock e al. 2000; Abu-Raddad e al.
2010; Gökengin e al. 2016; Saleh e al. 2020).
Fo una ely, nume ous an i e o i al d ugs (ARVs)
a e now accessible, which can enhance su i al a es and
elimina e he isk o ansmi ing HIV (Sisay e al. 2019).
Howe e , he op imal managemen o HIV in heal hca e
se ings elies no only on he clinical e icacy o ea men
egimens bu also on he p ac ices o heal hca e p o ide s
(Hawk e al. 2017).
Nume ous s udies indica e ha many physicians do
no consis en ly adhe e o he la es clinical guidelines
when p esc ibing ea men egimens (Cabana e al. 1999;
Lug enbe g e al. 2009a; Lug enbe g e al. 2009b; Ib aheem
Ali e al. 2019; Ali e al. 2025a). This inconsis ency can
a ise om a ious ac o s, including he complexi y o he
guidelines, le els o ins i u ional suppo , and he hea y
wo kload aced by p o ide s (Suá ez-Ga cía e al. 2014;
Tandon e al. 2019). Such de ia ions c ea e signi ican ba -
ie s o op imal pa ien ca e, ul ima ely impac ing ea -
men ou comes and he quali y o li e o indi iduals li ing
wi h HIV. Inadequa e aining and knowledge abou HIV
managemen among heal hca e p o essionals is a p e a-
len issue in I aq, which u he con ibu es o subop imal
pa ien ca e (Hamid Albujee e al. 2015; Nai e al. 2019;
Kaladha an e al. 2021). Addi ionally, poo communica ion
be ween pa ien s and heal hca e p o ide s can hinde pa-
ien s’ unde s anding o hei ea men plans and dec ease
hei engagemen in hei ca e (Budhwani e al. 2022).
These challenges a e u he compounded by a b oade
con ex o limi ed heal hca e esou ces, which diminishes
p o ide s’ capaci y o deli e comp ehensi e ca e (Ki aha a
e al. 2002). In I aq, he dis ibu ion o heal hca e acili ies
is une en, wi h ad anced hospi als and clinics concen-
a ed in es ablished u ban a eas, esul ing in subs an ial
geog aphic dispa i ies. Despi e he comp ehensi e ame-
wo k, he heal h sys em con inues o ace ongoing chal-
lenges in esou ce alloca ion, pe sonnel dis ibu ion, and
supply managemen , as de ailed in he 2024 Heal h Sec o
and Pa liamen a y Heal h Commi ee epo s. In his e-
ga d, specialized HIV ca e and ART a e a ailable a eigh
dedica ed cen e s dis ibu ed in Baghdad and some majo
ci ies like Ki kuk, Bas ah, and E bil (Saleh e al. 2020). Ad-
di ionally, I aq had o e 11,000 egis e ed labo a o ies, p e-
dominan ly loca ed in u ban a eas, wi h he mos ad anced
acili ies si ua ed in Baghdad and o he majo ci ies. HIV
diagnosis p ima ily elies on apid es s, wi h con i ma o y
ELISA and Wes e n blo conduc ed a designa ed labo a o-
ies; howe e , molecula es ing capaci y o con i ma o y
diagnosis and i al load moni o ing emains limi ed. Vi al
load es ing is in i s ea ly s ages and a ailable a less han
50% o HIV ca e si es, posing signi ican challenges o
long- e m ea men and managemen (WHO 2024).
Unde s anding he heal hca e landscape su ounding
HIV managemen is c ucial o de eloping a ge ed in e -
en ions ha imp o e ca e and suppo o pa ien s li -
ing wi h HIV. Un o una ely, o da e, he e is a signi ican
lack o da a ega ding he speci ic ole o heal hca e p o-
ide s in he managemen o HIV among I aqi pa ien s.
The e o e, his s udy aims o gain in-dep h insigh s in o
he p ac ices and challenges aced by heal hca e p o ide s
in managing HIV pa ien s in I aq, as well as hei ecom-
menda ions o imp o emen . By iden i ying hese c i ical
challenges and unde s anding he pe spec i es o heal h-
ca e p o ide s, his esea ch seeks o in o m policymak-
e s o exis ing gaps and con ibu e o he de elopmen
o mo e e ec i e heal hca e s a egies ha enhance HIV
managemen and ul ima ely imp o e heal h ou comes o
pa ien s li ing wi h HIV in I aq.
Me hods
S udy design
To achie e he s udy’s objec i es, a quali a i e s udy was
conduc ed using ace- o- ace, indi idual-based in e -
iews wi h physicians cu en ly wo king in HIV cen e s.
The s udy was e hically app o ed by he Resea ch E hical
Commi ee a he College o Pha macy, Baghdad Uni e si-
y (App o al No. REC06202567R, da ed 13 Oc obe 2024).
De elopmen and alida ion o he in-
e iew guide
The s udy au ho s de eloped he in e iew guide (Suppl.
ma e ial 1) based on ele an in o ma ion om p e ious
s udies (Ri e o-Méndez e al. 2010; Campbell e al. 2011;
Pha macia 72: 1–15 3
Renju e al. 2017; Igihozo e al. 2022; Pan e al. 2022). The
con en alida ion o he guide was conduc ed by sending
i o a panel o ou expe s ( h ee academic pha macis s
wi h ex ensi e expe ience in quali a i e esea ch, along
wi h a consul an physician who wo ks a an HIV cen e ).
All expe s we e eques ed o e alua e each ques ion using
a 3-poin scale: “ ele an and essen ial,” “ ele an bu no
essen ial,” and “no ele an .” Addi ionally, expe s we e
asked o p o ide eedback on any language and ph asing
issues. Lawshe’s me hod was used o e alua e he con en
alidi y o he in e iew guide (Lawshe 1975). All pa ici-
pa ing expe s conside ed all i ems in he de eloped guide
o be ele an and essen ial.
Se ing and pa icipan ec ui men
me hod
The s udy sample included physicians who wo k in HIV
cen e s a h ee di e en go e no a es in I aq (Baghdad,
Ki kuk, and E bil). To ensu e su icien expe ience in
managing and dealing wi h HIV pa ien s, only physicians
wi h a leas 6 mon hs o wo king expe ience a he HIV
cen e we e conside ed eligible o pa icipa e in his s udy.
All eligible physicians we e con ac ed be o e he in e iew
o in o m hem o he s udy’s pu pose. Gi en he limi -
ed numbe o physicians wo king a he HIV cen e s, all
eligible physicians who p o ided hei w i en in o med
consen we e included in he s udy h ough a consensus
sampling app oach. All physicians we e in e iewed in a
quie a ea a he HIV cen e .
Da a collec ion
The in e iews we e conduc ed using semi-s uc u ed,
open-ended ques ions om he de eloped and alida ed
in e iew guide (Suppl. ma e ial 1). P obes we e used o
ga he addi ional commen s as needed. The in e iews
we e ca ied ou in A abic by he i s au ho , a mas e ’s
candida e in clinical pha macy, ollowing aining in quali-
a i e in e iewing echniques h ough pilo in e iews su-
pe ised by he second au ho , who holds a PhD in clinical
pha macy and has expe ience in conduc ing and publish-
ing quali a i e esea ch. All in e iews we e audio- eco d-
ed wi h a mobile de ice. Each in e iew las ed app oxi-
ma ely 15 o 30 minu es. To each he equi ed sample, he
in e iews con inued om Feb ua y o Ap il 2025.
Thema ic analysis
All in e iews we e manually coded by he i s au ho and
used o so he quali a i e da a. A codebook was de el-
oped o ensu e consis en coding ac oss in e iews. Codes
we e agg ega ed o gene a e hemes and sub hemes using
a hyb id amewo k (a combina ion o deduc i e and in-
duc i e models) (Fe eday and Mui -Coch ane 2006; Gale
e al. 2013). In he induc i e pa , a p e iously p epa ed
empla e based on he sec ions o he in e iew guide was
used. The six s eps o B aun and Cla ke’s model o he-
ma ic analysis we e applied in he deduc i e app oach
(B aun and Cla ke 2006). Fo he pu pose o p esen ing
pa icipan s’ quo a ions, he i s au ho ansla ed e ba-
im in o English.
Resul s
Demog aphic in o ma ion
Se en een physicians wo king in HIV cen e s we e in i ed
o pa icipa e and we e in e iewed in he cu en s udy.
Se en physicians we e wo king a Al-Ka ama HIV Cen e
(Baghdad), i e a Ki kuk HIV Cen e , and i e a E bil
HIV Cen e . The a e age age o s udy pa icipan s was
33.24 yea s, wi h a ange om 26 o 59 yea s. The du a-
ion o wo king expe ience a HIV cen e s a e aged 21.71
mon hs, anging om 5 mon hs o 6 yea s, as shown in
Table 1 and Table 2.
S udy hemes
The da a ob ained om he s udy in e iews led o he
iden i ica ion o ou key hemes essen ial o he e ec-
i e managemen o HIV pa ien s. These included clinical
p ac ices in he managemen o HIV, he oles o heal h-
ca e p o essionals, pa ien adhe ence o p esc ibed an-
i-HIV he apy, and he heal hca e se ices a ailable o
HIV pa ien s, as shown in Table 3.
Clinical p ac ice in he managemen o
HIV pa ien s
Fac o s conside ed in he selec ion o he
ea men egimen
Rega ding he basis o selec ing ea men egimens o
HIV pa ien s, mos pa icipan s (n = 13) epo ed adhe -
ing o he I aqi Minis y o Heal h (MOH) guidelines; o
hese, i e indica ed ha he MOH guidelines a e based on
WHO guidelines. Only wo physicians epo ed ha hei
ea men selec ion was solely based on WHO guidelines.
Table 1. Demog aphic cha ac e is ics o he in e iewed phy-
sicians.
Pa ame e Value
Age (yea s) Range 26–59
Mean ± SD 33.24 ± 9.75
Sex Male,n (%) 7 (41.18)
Female,n (%) 10 (58.82)
Academic deg ee Boa d 2 (11.76)
Mas e 1 (5.88)
Boa d s uden 10 (58.82)
BSc 4 (23.53)
Special y o ield o
p ac ice
In e nal medicine 6 (35.29)
Family medicine 10 (58.82)
Clinical immunology 1 (5.88)
Wo king expe ience
(in mon hs)
Range 5–72
Mean ± SD 21.71 ± 20.46
Talabani SN & Mikhael EM: Quali a i e insigh s in o HIV managemen in I aq4
Among hose physicians, ou conside ed d ug a ailabili y a
he HIV cen e in addi ion o he ea men guidelines when
p esc ibing HIV he apy. Addi ionally, wo pa icipan s no -
ed ha ac o s such as i al load, CD4 coun s, o como bid
condi ions could in luence hei decision-making p ocess.
“The selec ion o ea men egimens o HIV pa ien s
is ypically based on he Minis y o Heal h guidelines,
which he WHO app o es. Addi ionally, we conside he
a ailabili y o he egimen a he cen e .” P3
“The selec ion o a ea men egimen o an HIV pa-
ien is based on se e al impo an ac o s, including CD4
coun , i al load, and como bid condi ions. “ P2
Recommended i s -line ea men egimen
All he pa icipa ing physicians ag eed ha TLD is he
i s -line egimen mos equen ly ecommended o HIV
pa ien s in hei ins i u ions. They ci ed se e al easons
o his p e e ence, including highe e ec i eness (n = 7),
lowe isk o side e ec s (n = 5), educed isk o esis ance
(n = 2), g ea e accep abili y o his egimen compa ed o
olde op ions, and i s a ailabili y (n = 3) a HIV cen e s.
“Nowadays, we use TLD as i s -line he apy o HIV
pa ien s due o i s low isk o side e ec s.” P6
“In I aq, he ea men p o ocol o HIV pa ien s con-
sis s o TLD, which is ecommended by he WHO guide-
lines due o i s high e ec i eness in lowe ing i al load.” P2
Ba ie s in he managemen o HIV pa ien s
In explo ing he challenges aced by physicians in manag-
ing HIV/AIDS pa ien s, pa icipan s epo ed expe ienc-
ing mul iple di icul ies. The mos equen ly iden i ied
challenge was pa ien s’ limi ed adhe ence o p esc ibed
ea men , epo ed by eigh physicians. Addi ionally, i e
physicians highligh ed limi ed adhe ence o ollow-up
Table 2. De ailed demog aphics o s udy pa icipan s.
Numbe o pa icipan s Age Sex Academic deg ee Special y Wo king expe ience
P1 56 Male PhD In e nal medicine 5 yea s
P2 59 Male PhD In e nal medicine 6 yea s
P3 40 Female MSc clinical immunology 5 yea s
P4 27 Female 3 d boa d Family medicine 9 mon hs
P5 28 Female Residen Family medicine 1 yea & 2 mon hs
P6 26 Female 2nd boa d Family medicine Almos a yea
P7 28 Female Residen Family medicine Yea & 5 mon hs
P8 29 Female Residen Family medicine Yea & 6 mon hs
P9 27 Female Residen Family medicine Yea
P10 33 Male 3 d boa d in e nal medicine Yea
P11 30 Male 2nd boa d In e nal medicine 10 mon hs
P12 33 Male 3 d boa d In e nal medicine Yea & 3 mon hs
P13 31 Male 3 d boa d In e nal medicine Yea
P14 33 Male 3 d boa d In e nal medicine Yea
P15 29 Female 2nd boa d Family medicine Yea
P16 29 Female 2nd boa d Family medicine Yea
P17 27 Female 4 h boa d Family medicine 10 mon hs
Table 3. S udy hemes.
Theme Sub heme
Clinical p ac ice in he managemen o HIV pa ien s Fac o s conside ed in he selec ion o a ea men egimen
Recommended i s -line ea men egimen
Ba ie s in he managemen o HIV pa ien s
Roles o heal hca e p o essionals in he managemen o HIV
pa ien s
Moni o ing esponse o p esc ibed he apy
Moni o ing side e ec s o p esc ibed he apy
P e en ion and ea men o he ad e se e ec s o p esc ibed an i-HIV
he apy
Adhe ence o pa ien s o p esc ibed an i-HIV he apy Le el o medica ion adhe ence
Consequences o medica ion non-adhe ence
Ba ie s o medica ion adhe ence
Facili a o s o medica ion adhe ence
Implemen ed s a egies o enhance pa ien adhe ence o p esc ibed he apy
Heal hca e se ices o HIV pa ien s Quali y o heal hca e se ices
A ailabili y and accessibili y o HIV cen e s
Recommenda ions o imp o e ca e o HIV pa ien s
Pha macia 72: 1–15 5
isi s as a signi ican ba ie . Some physicians also no -
ed ha pa ien s’ e usal o ini ia e ea men (n = 4) and
misconcep ions abou he disease, such as belie s ha HIV
is incu able (n = 3), we e common obs acles in e ec i e
managemen . O he di icul ies included poo compliance
wi h physician ins uc ions (n = 2), a limi ed le el o us
in he e icacy o he d ug (n = 1), and a limi ed le el o
us in he physician’s compe ence (n = 1). These indings
sugges ha mul iple pa ien - ela ed ac o s con ibu e
o he complexi ies o HIV/AIDS managemen om he
physicians’ pe spec i es.
“The mos common ba ie s o ea ing HIV pa ien s
a e ela ed o pa ien s’ pe cep ions ha HIV is a a al dis-
ease and hei conce ns abou p ognosis, o en asking
abou he da e o dea h. Addi ionally, pa ien s wi h limi ed
heal h li e acy ace challenges, as hey may belie e ha is-
i ing he HIV cen e o ea men will esul in qua an ine
o s igma. This misconcep ion leads o missed appoin -
men s and poo adhe ence o hei ea men egimen.” P3
“I hink ha he main ba ie in he ea men o HIV
pa ien s is ela ed o hei poo compliance wi h physician
ins uc ions. Fo example, some pa ien s did “Hijama,”
which may inc ease he chance o ansmission o HIV o
heal hy indi iduals.” P12
Roles o heal hca e p o essionals in he
managemen o HIV pa ien s
Moni o ing esponse o p esc ibed he apy
All pa icipa ing physicians epo ed engaging in moni-
o ing he esponse o HIV pa ien s o p esc ibed ea -
men . Among hem, eigh physicians indica ed ha mon-
i o ing was conduc ed 3 mon hs a e ea men ini ia ion
and hen e e y 6 mon hs he ea e . Fou physicians de-
sc ibed hei moni o ing p ac ices as pe iodic bu did no
speci y exac in e als. Two physicians epo ed moni o -
ing du ing e e y mon hly isi o he HIV cen e . Con-
e sely, h ee physicians men ioned ha hey moni o ed
pa ien s wi hou p o iding u he de ails ega ding he
iming o equency o assessmen .
All physicians ag eed ha moni o ing pa ien s’ e-
sponse o ea men was hei esponsibili y in acco dance
wi h hei ins i u ion’s policies. They p ima ily elied on
labo a o y es ing o i al load o assess ea men e-
sponse. Addi ionally, some physicians epo ed e alua ing
o he pa ame e s, including comple e blood coun (n = 6)
and pa ien weigh (n = 2). Fu he mo e, six physicians
indica ed ha hey conduc ed clinical examina ions and
moni o ed pa ien symp oms as pa o hei app oach o
e alua e he e ec i eness o p esc ibed he apy.
“We moni o pa ien s’ esponse o ea men by collec -
ing essen ial da a du ing each isi o he cen e . This in-
cludes conduc ing labo a o y es s such as comple e blood
coun s (CBC) and i al load assessmen s o e alua e he
e ec i eness o he he apy. “ P8
“Moni o ing pa ien esponse o p esc ibed he apy is
ypically pe o med h ee mon hs a e ini ia ing ea -
men , h ough i al load es ing and comple e blood
coun s (CBC). Addi ionally, we conduc a clinical ex-
amina ion, assess he pa ien ’s weigh , and e alua e hei
o e all heal h s a us.” P14
Moni o ing side e ec s o p esc ibed he apy
Rega ding he ad e se e ec s associa ed wi h cu en an-
i e o i al he apies, se e al physicians iden i ied bo h
sho - e m and long- e m side e ec s expe ienced by HIV
pa ien s. Thi een physicians epo ed one o mo e sho -
e m ad e se e ec s, including dizziness (n = 7), a igue
(n= 6), headache (n = 6), alle gic eac ions (n = 6), and
nausea (n = 2). No ably, ou esponden s indica ed ha
he side e ec s o TLD we e gene ally less se e e com-
pa ed o hose associa ed wi h olde ea men egimens.
In e ms o long- e m ad e se e ec s, ou physicians
highligh ed hype lipidemia as a signi ican conce n, wi h
all epo ing i s occu ence among hei pa ien s. Addi-
ionally, wo physicians men ioned he ele a ion o li e
enzymes as a po en ial long- e m complica ion ela ed o
TLD he apy.
“Fa igue and dizziness can occu in pa ien s bu disap-
pea wi hin days. “ P 11
“Mos pa ien s do no su e om side e ec s, bu wi h
long pe iods o use, lipid le els may be ele a ed, and li e
unc ion may also be impai ed.” P8
All physicians epo ed moni o ing pa ien s o po en-
ial d ug side e ec s, conside ing his an essen ial pa o
hei esponsibili ies in acco dance wi h ins i u ional pol-
icies. Twel e physicians moni o ed one pa ame e , while
i e physicians moni o ed wo o mo e pa ame e s. Fi -
een physicians ou inely inqui ed abou symp oms ela -
ed o medica ion side e ec s; among hem, eigh ad ised
pa ien s o seek u gen medical a en ion i hey de el-
oped abno mal symp oms, whe eas he emaining se en
assessed symp oms du ing ou ine isi s a he HIV ca e
cen e . Moni o ing h ough labo a o y in es iga ions was
epo ed by eigh physicians, who u ilized blood es s o
de ec ad e se e ec s, especially long- e m side e ec s.
Addi ionally, h ee physicians desc ibed conduc ing phys-
ical and clinical examina ions o assess he de elopmen
o side e ec s du ing pa ien consul a ions.
“Yes, i is ou job o moni o pa ien s o d ug side e -
ec s h ough clinical examina ions and by e iewing he
esul s o labo a o y es s.” P10
“Du ing mon hly isi s, we assess he pa ien ’s signs
and symp oms. Addi ionally, side e ec s may be de ec ed
h ough con inuous communica ion be ween he pa ien
and physician, including physician-ini ia ed ollow-up
calls and u gen pa ien -ini ia ed calls in abno mal si u-
a ions. Such ac ions a e ce ainly he esponsibili y o he
physician.” P17
Talabani SN & Mikhael EM: Quali a i e insigh s in o HIV managemen in I aq6
P e en ion and ea men o ad e se e -
ec s o p esc ibed an i-HIV he apy
In add essing he mi iga ion o ad e se d ug e ec s, ou
physicians highligh ed he impo ance o pa ien eassu -
ance h ough educa ion abou he ypically ansien na u e
o mos side e ec s. One physician speci ically emphasized
he impo ance o counseling pa ien s on heal hy ea ing
habi s as a p e en i e measu e. The emaining physicians
epo ed ha hey did no implemen speci ic s a egies o
p e en side e ec s bu ins ead concen a ed on managing
and ea ing pa ien s who expe ienced in ole able ad e se
e ec s and some imes e e ed hem o o he specialis s.
“Educa e pa ien s o con inue hei ea men and no
o s op i since mos side e ec s will disappea in he i s
en days.” P2.
“Fo pa ien s wi h pe sis en ash, we e e hem o de -
ma ologis s. In cases o de eloping nausea and headache,
we p esc ibe a ea men o elie e hese side e ec s.” P16.
Adhe ence o pa ien s o p esc ibed an-
i-HIV he apy
Le el o medica ion adhe ence
Mos pa icipa ing physicians (n = 16) pe cei ed ha mos
HIV pa ien s demons a ed good adhe ence o hei p e-
sc ibed he apy. In con as , only one physician epo ed
ha mos HIV pa ien s exhibi ed poo adhe ence o hei
ea men egimens.
Rega ding pa ien g oups pe cei ed as less likely o ad-
he e o ea men , nea ly all physicians iden i ied a leas
one such g oup. The mos epo ed g oup comp ised el-
de ly pa ien s (n = 9), who we e belie ed o ha e poo e
adhe ence, po en ially due o ac o s such as polypha -
macy, o ge ulness, o eelings o hopelessness. Fi e phy-
sicians iden i ied pa ien s wi h low educa ional le els o
limi ed heal h li e acy as being a highe isk o non-ad-
he ence. Fou physicians no ed ha newly diagnosed pa-
ien s ended o ha e poo adhe ence ini ially; howe e ,
adhe ence o en imp o ed wi h subsequen isi s and a e
ob aining low i al load esul s in labo a o y es s. Addi-
ionally, h ee physicians conside ed younge pa ien s
mo e likely o s uggle wi h adhe ence. The emaining
physicians iden i ied pa ien s wi h speci ic occupa ional
ac o s – such as hose wo king nigh shi s (n = 2) o em-
ployed in demanding jobs (n = 1) – as being a highe isk
o non-adhe ence.
“Mos pa ien s a e well adhe en o hei p esc ibed
he apy excep hose who ha e nigh shi wo k.” P3
“Mos pa ien s we e no adhe en o hei p esc ibed
he apy, o en missing he designa ed adminis a ion imes
and, in some cases, no aking he medica ion daily. “ P5
“Mos pa ien s adhe e o hei p esc ibed he apy; how-
e e , some elde ly pa ien s poo ly adhe e o hei he apy,
which may be due o hei usage o many medica ions and
due o o ge ulness.” P1
Consequences o medica ion non-adhe ence
Rega ding he consequences o non-adhe ence o medica-
ion, mos physicians (n = 13) epo ed obse ing nega i e
ou comes, p ima ily when non-adhe ence was p olonged.
These included se e e ches in ec ions (n = 5), li e p ob-
lems (n = 3), sep ic a h i is (n = 1), gas oin es inal in ec-
ions (n = 1), weigh loss (n = 1), and de e io a ion in o e all
heal h (n = 2). The emaining ou physicians did no e-
po wi nessing any nega i e clinical consequences among
non-adhe en pa ien s, o he han inc easing i al load.
“I know a young pa ien who go sep ic a h i is and se-
e e ches in ec ion because she did no ake he ea men
o 2 yea s.” P9
“Du ing my wo king pe iod in his cen e , I did no ob-
se e and deal wi h any pa ien whose case de e io a ed.” P11
Ba ie s o medica ion adhe ence
F om he physicians’ pe spec i e, he main pe cei ed ba -
ie s o pa ien s’ adhe ence o p esc ibed he apy includ-
ed misconcep ions abou HIV being a non-cu able and
a al disease (n = 8), s igma and shame associa ed wi h
isi ing he HIV cen e o ea men (n = 7), limi ed edu-
ca ional le els among pa ien s (n = 2), limi ed knowledge
abou he bene i s o medical he apy (n = 1), and o ge -
ulness (n = 1).
“S igma and eelings o shame associa ed wi h isi ing
he HIV cen e o hospi al each mon h o ecei e medi-
cal he apy can discou age some pa ien s om a ending,
leading hem o miss hei mon hly ee medica ions.” P1
“Dea h is o en he p ima y conce n associa ed wi h
HIV in ec ion, which can lead o eelings o hopeless-
ness among pa ien s. This pe cep ion is conside ed a
majo ba ie o hei op imal adhe ence o p esc ibed
he apy.” P13.
Facili a o s o medica ion adhe ence
Rega ding ac o s in luencing medica ion adhe ence,
mos physicians (n = 8) iden i ied pa ien educa ion abou
HIV and i s ea men as he p ima y de e minan . Fou
physicians emphasized ha psychological suppo could
enhance adhe ence among HIV pa ien s. Ano he ou
pa icipan s highligh ed he impo ance o amily sup-
po in imp o ing adhe ence. Fu he mo e, ou physi-
cians conside ed con inuous encou agemen and egula
con ac be ween pa ien s and heal hca e p o ide s o be
c ucial o p omo ing adhe ence. Las ly, wo physicians
sugges ed ha imp o ing pa ien s’ p i acy wi hin heal h-
ca e se ings could also con ibu e o inc eased adhe ence.
Pha macia 72: 1–15 7
“Inc ease pa ien awa eness abou he disease and ed-
uca e pa ien s abou he ea men and consequences o
missing ea men .” P6
“The main ac o in ensu ing op imal ea men is p o-
iding psychological suppo o he pa ien , along wi h
suppo om hei amily.” P4
Implemen ed s a egies o enhance pa ien
adhe ence o p esc ibed he apy
Rega ding he s a egies implemen ed a he HIV cen e
o imp o e adhe ence o he apy egimens, mos physi-
cians (n = 9) indica ed ha pa ien s we e p o ided wi h
he mobile numbe o a heal hca e p o ide o eme gen-
cy calls. They also epo ed ha some pa ien s we e ol-
lowed up h ough phone calls o emind hem o sched-
uled clinic appoin men s and upcoming ea men s (n =
3). Addi ionally, h ee physicians men ioned ha pe iodic
labo a o y es ing was pe o med o p omo e adhe ence.
Fu he mo e, wo physicians no ed ha ensu ing he
a ailabili y o ee medica ions was an impo an measu e
o suppo pa ien s’ adhe ence o hei medica ion.
“The physician’s mobile numbe is a ailable o he pa-
ien o ask ques ions and exp ess conce ns.” P10.
“Calling pa ien s be o e hei scheduled isi o he cen-
e o emind hem o he ou ine check-up and o collec
hei mon hly medica ions.” P14.
Heal hca e se ices o HIV pa ien s
Quali y o heal hca e se ices
Mos physicians (n = 10) conside ed he cu en heal hca e
se ices o HIV pa ien s in hei ins i u ions o be good.
Howe e , se en pa icipan s iewed hese se ices as good
in ce ain a eas bu poo in o he s. The mos ecognized
s eng h was he quali y o ca e p o ided by heal hca e
p o ide s, epo ed by 13 physicians. O he physicians
highligh ed ha good se ices included he a ailabili y o
ee medica ions (n = 2) and ee pe iodic labo a o y es -
ing (n = 2). Con e sely, i e physicians iden i ied he lack
o specialized se ices – such as den al clinics o su gical
hea e s – as he main ac o con ibu ing o lowe heal h-
ca e quali y in HIV cen e s. One physician epo ed ha
he absence o CD4 es ing was a signi ican ba ie o p o-
iding adequa e heal hca e, while ano he conside ed he
subop imal en i onmen o he HIV cen e he p ima y
obs acle o deli e ing good heal hca e se ices.
“The cu en se ices e ec i ely p o ide pa ien s wi h
ee medica ions and pe iodic check-ups. Howe e , he
cen e lacks a specialized a ea o pe o ming mino su -
ge ies o oo h ex ac ions o HIV-posi i e pa ien s. As
a esul , pa ien s equi ing oo h ex ac ions mus isi
o he hospi als o p i a e clinics. Many pa ien s a e hesi-
an o disclose hei HIV s a us due o ea ha hei cases
may no be managed app op ia ely, which inc eases he
isk o HIV ansmission.” P1
“The heal h se ices p o ided by he cen e and he
physicians o pa ien s a e o e y good quali y.”P4
A ailabili y and accessibili y o HIV cen e s
Mos pa icipa ing physicians conside ed he cu en HIV
cen e s in I aq o be su icien o he needs o HIV pa-
ien s. Howe e , wo physicians belie ed ha he num-
be o cen e s was insu icien , gi en he ising numbe
o newly diagnosed cases. Addi ionally, one physician
exp essed hope o inc ease he numbe o HIV cen e s,
belie ing ha expanding he acili ies would help imp o e
he quali y o ca e p o ided o pa ien s.
“The cu en numbe o HIV cen e s is su icien unless
he numbe is signi ican ly inc eased in he u u e.” P2
“The cu en numbe o HIV cen e s is insu icien ; in-
c easing hei numbe would help imp o e he quali y o
heal h se ices.” P8
Recommenda ions o imp o e ca e o HIV
pa ien s
To imp o e ea men ou comes o HIV pa ien s, pa ici-
pa ing physicians o e ed a ious ecommenda ions. Six
pa icipan s sugges ed es ablishing a psychia is clinic
wi hin he HIV cen e , while h ee ecommended adding a
den al clinic. Fou physicians emphasized he impo ance o
ensu ing g ea e p i acy o HIV pa ien s. Addi ionally, ou
physicians ad oca ed o ongoing pa ien educa ion abou
hei disease and ea men o enhance medica ion adhe -
ence. Th ee pa icipan s ecommended inc easing he num-
be o physicians wo king in HIV cen e s, and wo sugges ed
expanding he nu sing s a . Th ee physicians emphasized
he impo ance o ensu ing he a ailabili y o all necessa y
labo a o y es s. Las ly, wo physicians p oposed acili a ing
he hospi al admission p ocess o HIV pa ien s, and an-
o he wo belie ed ha p o iding incen i es o heal hca e
wo ke s in HIV cen e s could imp o e pa ien ou comes.
“Adding a psychia is clinic and a den al clinic wi hin
he HIV cen e . Inc easing pa ien p i acy is also ecom-
mended o imp o e he ca e o HIV pa ien s.” P12.
“Inc easing he numbe o physicians, pha macis s,
and nu ses in he cen e is ecommended o enhance ca e
o he pa ien s.” P10
“P o ide inancial incen i es o heal hca e wo ke s
in he HIV cen e o encou age hem o wo k in his o -
en-undesi ed se ing.” P3
Pa icipa ing physicians also ecommended se e al
measu es o educe he isk o HIV ansmission. These
Talabani SN & Mikhael EM: Quali a i e insigh s in o HIV managemen in I aq8
ini ia i es included inc easing pa ien and amily awa e-
ness abou he disease and i s modes o ansmission (n =
7), aising public awa eness abou HIV (n = 6), es ablish-
ing ee HIV es ing uni s in public o ices and uni e si ies
(n = 3), and enhancing HIV awa eness among heal hca e
p o ide s (n = 2).
“Inc ease public awa eness abou he disease o dispel
my hs and misconcep ions h ough social media, along-
side p o iding educa ion on p e en ion me hods.” P5
“O e ee HIV es ing uni s in uni e si ies, schools,
and wo kplaces o help p e en he ansmission o he
i us.” P13
Discussion
The esul s o he cu en s udy unde sco e he mul i ac-
e ed na u e o HIV ca e, highligh ing how each elemen
con ibu es o ea men success. Unde s anding hese
ac o s is c ucial o de eloping a ge ed in e en ions
ha enhance pa ien ou comes and op imize heal hca e
deli e y wi hin HIV managemen p og ams.
The esul s o his s udy showed ha mos pa icipa -
ing physicians epo ed adhe ing o he I aqi Minis y
o Heal h (MOH) guidelines, which a e mos ly based
on WHO guidelines, in hei selec ion o ea men eg-
imens o HIV pa ien s. Simila ly, local guidelines o
he managemen o A ican people wi h HIV ag ee wi h
WHO guidelines (Scheie e al. 2025). Meanwhile, some
physicians epo ed ha hei choice o HIV ea men
egimen was in luenced no only by es ablished ea -
men guidelines bu also by he a ailabili y o medica-
ions a he HIV cen e . This p oblem may a ise om he
ac ha he I aqi go e nmen inances ART and ela ed
HIV heal hca e se ices h ough he Minis y o Heal h,
as ou lined in na ional heal h legisla ion, p o iding ee
diagnosis, ea men , and ollow-up a designa ed HIV
cen e s o all egis e ed pa ien s. Howe e , unding luc-
ua ions and delays in budge disbu semen , as epo ed
in he 2024 Pa liamen a y Heal h Commi ee epo , ha e
led o pe iodic sho ages o medica ions and supplies, ad-
e sely a ec ing he con inui y o ca e o HIV and o he
ch onic condi ions (Jadoo 2024; Ali e al. 2025b). Sim-
ila ly, I aqi pa ien s wi h HIV expe ienced equen in-
e up ions in he supply o hei an i-HIV medica ions
(Talabani and Mikhael 2025). In line wi h hese obse -
a ions, ecen ecommenda ions om he Heal h Com-
mi ee unde sco e he p essing need o imp o ed heal h
sys em unding, imely budge ing, and be e wo k o ce
planning – all c i ical o sus aining essen ial se ices and
hence enhancing he quali y and eliabili y o HIV se -
ices (Saleh e al. 2020).
On he o he hand, a ew pa icipa ing physicians
conside ed ac o s such as i al load o CD4 coun s o
in luence hei decision-making p ocess. Howe e , his
app oach con adic s cu en ea men guidelines, which
ecommend ini ia ing an i e o i al he apy o HIV pa-
ien s ega dless o isk ac o s o CD4 coun . This p ac ice
is also commonly obse ed among Uk ainian physicians
(O esen e al. 2024). In addi ion, a ew o he pa icipa -
ing physicians in he cu en s udy epo ed ha pa ien s’
como bid condi ions could in luence hei selec ion o
ea men egimens. This inding e lec s good clinical
p ac ice, as physicians conside como bidi ies and he
po en ial in e ac ions be ween an i e o i al medica ions
and o he d ugs he pa ien s a e al eady aking o hei
como bid condi ions (Tseng e al. 2013).
Al hough pa icipa ing physicians iden i ied a ious
ac o s in luencing hei choice o ini ial he apy o new-
ly diagnosed HIV pa ien s, TLD emains he i s -line
egimen mos equen ly ecommended o HIV pa ien s
ac oss di e en HIV cen e s in I aq. This ecommenda-
ion was in line wi h he ecommenda ions by he la es
WHO ea men guidelines o HIV pa ien s (Tegegne e
al. 2024). Pa icipa ing physicians ci ed se e al easons
o hei p e e ence o TLD, including i s highe e ec-
i eness, lowe isk o side e ec s, educed po en ial o
esis ance, g ea e accep abili y compa ed o olde egi-
mens, and i s a ailabili y a HIV cen e s. These ad an ages
ha e been epo ed in nume ous s udies, suppo ing he
widesp ead use o TLD in many low- and middle-income
coun ies (Phillips e al. 2019; Kouamou e al. 2022).
Despi e hese ad an ages o TLD, mos physicians e-
po ed ha pa ien s expe ienced ansien and mild ad-
e se e ec s, especially a he s a o ea men wi h TLD,
such as dizziness, a igue, headache, alle gic eac ions, and
nausea. Howe e , hese side e ec s a e gene ally less se-
e e compa ed o hose associa ed wi h olde ea men
egimens. Few physicians epo ed he de elopmen o
long- e m side e ec s among some pa ien s on TLD, such
as hype lipidemia and an ele a ion o li e enzymes. Mos
o hese side e ec s we e also de ec ed among A ican HIV
pa ien s using highly ac i e an i e o i al he apy (Lesi e
al. 2009; Namulindwa e al. 2022; Fimbo e al. 2024).
Rega ding he ba ie s in he managemen o HIV
pa ien s, se e al challenges we e epo ed by pa icipa -
ing physicians. The mos p ominen among hese was
pa ien s’ inadequa e adhe ence o p esc ibed ea men
egimens and ollow-up appoin men s. This issue is no
unexpec ed, as he success ul managemen o HIV la gely
depends on pa ien s’ consis en adhe ence o an i e o i-
al he apy (Esca in e al. 2024). Addi ionally, pa ien s’
e usal o ini ia e ea men and widesp ead misconcep-
ions abou HIV and i s managemen we e iden i ied as
signi ican ba ie s by I aqi physicians. Simila challeng-
es a e obse ed among pa ien s in Kenya and Uganda
(Muhamadi e al. 2010; Kahn e al. 2013), whe e delays
in s a ing an i e o i al he apy due o misconcep ions
a e associa ed wi h poo e heal h ou comes and highe
mo ali y a es.
Rega ding he oles o physicians in managing HIV
pa ien s, all pa icipa ing physicians epo ed ac i ely
Pha macia 72: 1–15 9
moni o ing pa ien s’ esponses o p esc ibed ea men s,
as well as o e seeing po en ial d ug side e ec s. They e-
ga ded hese esponsibili ies as essen ial componen s o
hei du ies, in line wi h hei ins i u ional policies. In a
simila ein, in Japan, physicians play a mo e p ominen
ole han pha macis s in moni o ing he e ec i eness and
side e ec s o p esc ibed an i e o i al he apy. Howe -
e , e ec i e collabo a ion be ween physicians and pha -
macis s – whe e physicians p esc ibe medica ions and
pha macis s moni o d ug e icacy, side e ec s, and pa-
ien adhe ence – can enhance ou comes o HIV pa ien s
(U ano e al. 2020).
Fo moni o ing he e ec i eness o p esc ibed he apy,
mos physicians epo ed doing so by o de ing labo a o y
es s such as i al load and CBC and conduc ing clinical
examina ions. This app oach aligns wi h HIV ea men
guidelines and e lec s good clinical p ac ice among I aqi
physicians in he managemen o HIV pa ien s (Vajpayee
and Mohan 2011).
To add ess he sho - e m side e ec s o TLD, some
physicians epo ed eassu ing pa ien s h ough educa-
ion abou he ypically ansien na u e o mos side e -
ec s. Addi ionally, mos physicians ou inely inqui ed
abou symp oms ela ed o medica ion side e ec s and
ad ised pa ien s o seek u gen medical a en ion i hey
de eloped any abno mal symp oms. Fu he mo e, pa ic-
ipa ing physicians epo ed conduc ing pe iodic labo a o-
y es ing o pa ien s using TLD o e ex ended pe iods
o acili a e ea ly de ec ion and managemen o po en ial
long- e m side e ec s. This p oac i e app oach e lec s
he bes clinical p ac ices aimed a ensu ing op imal ca e
o I aqi pa ien s li ing wi h HIV (Fe nandez-Mon e o e
al. 2013). The indings om physicians align wi h epo s
om HIV-posi i e pa ien s, who gene ally pe cei ed he
heal hca e se ices hey ecei ed as good, pa icula ly
highligh ing he a en i e ca e p o ided by physicians (Ta-
labani and Mikhael 2025).
Rega ding he adhe ence o pa ien s o p esc ibed
an i-HIV he apy, mos pa icipa ing physicians pe -
cei ed ha mos HIV pa ien s demons a ed good ad-
he ence o hei p esc ibed he apy. The physicians’
pe spec i es align wi h he sel - epo s o I aqi HIV
pa ien s (Talabani and Mikhael 2025). Simila ly, mos
HIV pa ien s in di e en A ican (Yaya e al. 2014; Le -
a e al. 2015) and Asian coun ies (Aye e al. 2017; Aba-
diga e al. 2020) had good adhe ence o hei p esc ibed
ea men . This good adhe ence may be a ibu ed o
he na u e o he cu en ly used ea men egimen
(TLD), which is simple, aken once daily o ally, and
can be adminis e ed a any ime o he day (Tegegne
e al. 2024) wi hou ega d o meals, in addi ion o i s
good ole abili y and minimal and ansien side e ec s
(Keene e al. 2021).
Despi e good adhe ence o an i-HIV he apy by mos
pa ien s, a ew we e no adhe en . In his ega d, mos
physicians epo ed obse ing nega i e ou comes, pa -
icula ly when non-adhe ence was p olonged. These
included se e e in ec ions ha o en equi ed hospi-
aliza ion. This inding aligns wi h epo s om I aqi
HIV pa ien s, whe e some indi iduals who missed hei
ea men o se e al mon hs expe ienced a signi ican
inc ease in i al load (Talabani and Mikhael 2025). Sim-
ila ly, a c oss-sec ional s udy among Indonesian HIV pa-
ien s linked medica ion non-adhe ence wi h an ele a-
ion in i al load and an inc eased isk o oppo unis ic
in ec ions (Nu salam e al. 2024).
Acco ding o he cu en s udy esul s, physicians
iden i ied o ge ulness, polypha macy, eelings o hope-
lessness, limi ed heal h li e acy, misconcep ions abou
HIV, and s igma and shame associa ed wi h HIV as he
p ima y ba ie s o pa ien s’ adhe ence o an i e o i al
he apy. Simila ly, mos o hese challenges ha e been
ound o signi ican ly educe adhe ence among Indian
HIV pa ien s o hei p esc ibed ea men s (Achappa e
al. 2013). Conside ing hese ba ie s, many physicians
in he cu en s udy ega ded pa ien educa ion abou
HIV and i s ea men , along wi h psychological and
social suppo , as c ucial s a egies o imp o e medi-
ca ion adhe ence. This pe spec i e aligns wi h exis ing
li e a u e; o ins ance, a andomized s udy by Gouja d
and colleagues demons a ed ha educa ional in e en-
ions signi ican ly enhanced medica ion adhe ence by
inc easing pa ien s’ knowledge abou he disease and
i s ea men (Gouja d e al. 2003). Meanwhile, se e al
s udies ha e also highligh ed he posi i e impac o so-
cial and psychological suppo on medica ion adhe ence
among HIV pa ien s (Woodwa d and Pan alone 2012;
Spaan e al. 2020).
Rega ding he s a egies implemen ed a he HIV
cen e o imp o e adhe ence o he apy egimens, mos
physicians epo ed p o iding pa ien s wi h hei mobile
numbe s o eme gency con ac . They also no ed ha
some pa ien s we e ollowed up wi h h ough phone calls
o emind hem o scheduled clinic appoin men s and
upcoming ea men s. These s a egies a e well-docu-
men ed in he li e a u e as e ec i e measu es o enhanc-
ing medica ion adhe ence. Fo ins ance, a me a-analysis
demons a ed ha eminde ollow-up calls signi ican ly
ein o ced adhe ence beha io s (Jong e al. 2017). Addi-
ionally, a ecen sys ema ic e iew ound ha p o iding
HIV pa ien s wi h hei physician’s mobile numbe can
help build appo , acili a e immedia e suppo o ad-
d essing conce ns, and he eby imp o e medica ion ad-
he ence, ul ima ely leading o be e heal h ou comes o
HIV pa ien s (Ngcobo e al. 2022).
Rega ding he quali y o heal hca e se ices, mos
physicians conside ed he cu en heal hca e se ices o
HIV pa ien s in hei ins i u ions o be sa is ac o y; how-
e e , some highligh ed he impo ance o inco po a ing
addi ional specialized se ices, such as den al clinics and
su gical hea e s, wi hin HIV cen e s o enhance o e -
all pa ien ca e. These indings a e consis en wi h e-
po s om pa ien s a HIV cen e s in I aq (Talabani and
Mikhael 2025). In addi ion o he p e iously men ioned
