Preventing weight gain for people living with HIV in rural KwaZulu-Natal, South Africa: A qualitative study of perspectives and strategies.

BACKGROUND: Tenofovir disoproxil fumarate, lamivudine and dolutegravir (TLD) have become the first-line antiretroviral regimen in national HIV treatment programs throughout Southern Africa, including in South Africa. This is largely due to the excellent efficacy, tolerability and affordability. However, this transition to TLD has also been associated with excess weight gain and new-onset obesity in both new initiators of antiretroviral therapy (ART) and those who transition to TLD. METHODS: in rural KwaZulu-Natal. The Causal Continuum Model for Obesity was used to guide the development of data collection instruments and the analysis. RESULTS: Most participants expressed a wish for a slightly smaller body size as ideal. However, they simultaneously rejected the notion of a desire to appear thin, associating thinness with illness. They also expressed concern about stigma from family and friends if they were to experience rapid or large weight loss. We also found that overweight and obese people living with HIV in this rural community consistently associated large body sizes with an increased risk of high blood pressure, diabetes and other health complications. Lastly, the participants expressed an interest in exercise-based and pharmacologic interventions to prevent weight gain or promote weight loss in particular, but had little interest in diet modification for this purpose. CONCLUSION: Efforts to develop interventions to address obesity in people living with HIV should consider those that include exercise or pharmacologic anti-obesity therapies in their design and implementation.