Provider's and stakeholders' experiences with and perceptions of the benefits and challenges of delivering care for noncommunicable diseases within HIV care services in Rwanda

Abstract Background The growing burden of noncommunicable diseases (NCDs) among people living with HIV (PLHIV) in sub-Saharan Africa, including Rwanda, presents a complex healthcare challenge. Delivering NCD care within HIV services is crucial for improving patient outcomes and requires a coordinated, multistakeholder approach, but evidence on implementation experiences remains limited. Methods This qualitative study explored healthcare providers' and stakeholders’ experiences and perceptions regarding the delivery of NCD care within HIV services in Rwanda. A total of 49 in-depth interviews were conducted with healthcare providers from 12 health facilities across five provinces as well as with stakeholders from HIV and NCD programs. The participants were purposefully selected on the basis of their roles in HIV and NCD care. The interviews were conducted in Kinyarwanda or English, transcribed verbatim, and analysed thematically via Dedoose software. Data triangulation was applied to ensure the validity and reliability of the findings. Results The study revealed that NCD care for PLHIV in Rwanda remains largely fragmented. Most participants reported that patients diagnosed with NCDs are referred to separate departments or facilities, leading to discontinuities in care. Despite the decentralisation of NCD services, significant challenges remain, including inadequately trained staff, a lack of integration, NCD management guidelines, weak referral and follow-up systems, and delays in diagnosis. Financial barriers, due to out-of-pocket costs for NCD medication, further impede access. High-risk groups are identified as older adults, obese people, and those with compromised immune function. The participants called for greater integration of NCD services with existing HIV care platforms. Conclusion Delivering NCD care within HIV services in Rwanda faces multiple systemic barriers, including fragmented service delivery, shortages and inadequate provider capacity in NCD management, and financial and referral constraints. To improve outcomes for PLHIV with NCDs, integrated care models, targeted provider capacity building, strengthened referral systems, and expanded financial protection mechanisms are urgently needed. Addressing these gaps will enhance patient care and strengthen the overall health system in Rwanda.