The study was conducted with the aim of determining chronic comorbidity and self-management skills among adult HIV patients. In the present study prevalence of hypertension and diabetes mellitus (chronic comorbidities) among adult HIV patients was lower. Being older, overweight, and obese was shown to be significantly associated with chronic comorbidity. The total score of self-management was lower, and the lowest mean score was observed in the second domain, social support, and HIV self-management.
The estimated prevalence of hypertension in the present study was 9%, which is lower than studies conducted among HIV-positive patients of other parts of Ethiopia, Wolaita (15.9%), Jimma (34%), and Harar (12.7%) [32–34]. It is also lower than the finding from Uganda (27.9%) . The possible reason for our relatively low hypertension prevalence could be the high percentage (65%≤40 years old) of young people among our study participants. In addition to age, duration of therapy, type of ART, and lifestyle of participants could be important contributing factors for the discrepancy. To address this, further research should be done with a longitudinal study design.
In the present study, we also observed a lower prevalence of diabetes (1.5%) compared to studies conducted among adult HIV patients of Harar, Jimma, and Wolaita which were, 7.1%, 6.4 %, and 8%, respectively [32–34]. But it is comparable with other studies conducted in South Africa (1.3%) and Kenya (1.5%) [45, 46]. The observed difference could be due to variations in age distribution or duration of treatment of the study participants. Further research with a longitudinal study design is needed to understand the reason for this discrepancy.
In our study, chronic comorbidity was more prevalent among older HIV patients, which is in line with the study conducted in northern Ethiopia, Zambia, and Denmark [47–49]. Chronic comorbidity was seen more among overweight and obese participants than normal weight and underweight participants, which is in agreement with studies conducted in Nigeria and Botswana [40, 50]. It was also supported by a systematic review and meta-analysis reports of prospective cohort studies on comorbidity related to obesity and overweight, which indicates a significant association between the incident of chronic comorbidity with overweight and obesity . HIV management programs should consider the health consequences of overweight and obesity and should strengthen weight management programs as a part of routine HIV care.
In the current study, the total score of HIV self-management was lower than the one conducted by Webel et al in the US . There are some elements where people scored low self-management practice than others, like attending support groups as an important part of their HIV self-management strategy and helpfulness of educating others about HIV to stay in control of HIV. Even though sub-Saharan African countries are areas which are bitten by the highest burden of HIV, self-management in this region is relatively a new concept and not well researched . In addition, unlike the developed countries, chronic disease self-management programs, which are helpful to improve the self-management ability of PLWH, are not well-functioning [53–56]. This difference reminds the need to seek an urgent implementation program on HIV self-management to improve the self-management ability of people living with HIV in Ethiopia.
Our study showed that the second domain of the self-management scale, social support of HIV, had the lowest mean score (1.69 ± 0.92), which is in line with the study conducted in the Liangshan area of China . A low score in this domain indicates that HIV patients receive little support from people close by since this domain includes concepts of social influence, social support, and collaboration with healthcare professionals . The Studies conducted in South Africa and Uganda indicated that more social contact increased quality of life among people on ART [58, 59]. Another study also indicated that social support is an important aspect of disease self-management . Social support has got a buffering effect against stressors by providing informational support, emotional support, companionship support, and instrumental support (including provision of specific services to reduce client needs) [61–63]. The current study area, Ethiopia is known for strong social relationship, which makes this study finding paradoxical. The high existence of stigma and discrimination among PLWH in the study area  could be the plausible reason for this finding. Implementation of mainstreaming activities on stigma and discrimination prevention should be given more emphasis and further research should be done with new scale on each domain.
As a strength of our study, we would like to mention the facts that our data collectors were nurses and had expertise in HIV management. They could assist the participants in understanding and completing the questionnaires, they observed while the participants were being challenged in understanding the different options in each item of the questionnaire. Specially, understanding the items of the self-management scale was reported to be challenging. Specifically, the difference between not applicable and none of the time was difficult. This probably led to misunderstanding of the questions and may have resulted in measurement bias. In addition, the data-collectors reported back that quite a few of the items were difficult to apply in an Ethiopian context. For example, attending social support group when they are overwhelmed and this might be because of fear stigma and discrimination. Therefore, we feel that developing a new questionnaire for self-management for low-income setting is needed.