<p>Participant demographics.</p>

Physicians were sampled to ensure variability in training background and region, and 14 physicians were interviewed to reach thematic saturation. Barriers and facilitators discussed by both groups were organized into major themes following a socioecological model: patient, provider, local clinic/hospital, regional, and national health system. Peru-specific themes identified included: concern about practicing outside of one’s specialty (“intrusismo”), patient trust, the role of HIV coordinators and insurance, and the importance of national clinical practice guidelines.

This study highlights the complex interplay between patient, provider, local, regional, and national factors that influence delivery of care to PLWH in Peru. Addressing the barriers will require co-creation of resource-adaptable national HIV guidelines, with the participation of providers, program coordinators, and patients. These guidelines should encompass not only NCD management and educational resources for HIV providers and patients, but also processes and implementation pathways.

This will require coordination between existing NCD and HIV health programs, and generation of epidemiologic data on NCD in PLWH to optimize resource allocation.</p></div>