Table 2.

The Impact of COVID-19 on Cardiovascular Behaviors in PLWH

Theme	Description	Quote	Implication on CVD Health Behaviors
Promotion of Self-Care	This encompassed social interactions, hygiene habit changes, mask wearing, and social distance (all-encompassing theme).	“Since the onset of the coronavirus I have not been to any family gatherings, no parties. Of my church events I do that streaming from the internet. No one has visited. I's been a little bit quiet. I have a dog though that keeps me company and also have a roommate so I just haven't really done much of anything other than cardiac rehab and going to the grocery store. And tha's pretty much it. I did visit a friend once a few months ago, but tha's the only visitation that I have done or received since the virus was announced.”- Male PLWH	- Promote health behaviors recommended by medical professionals and the CDC including mask wearing, social distancing and following lockdown mandates in order to promote health during public health crises.
Diet Modifications During COVID-19	The pandemic directly impacted diet, in various ways. Some people of have consumed more food “depression eating” and gained weight, others have stopped eating out as much and lost weight.	“Once the pandemic’s open and say dining rooms are open for the restaurants, I really don’t think I’m gonna go back to them. I mean I’ve found I guess healthier alternatives to eat from home, for less money. You know, a hamburger versus I can buy a bag of hamburgers for $13.00 where it cost me $13.00 for three hamburgers at a restaurant and I can have meals for four days with the hamburgers I buy. So, I’m finding I don’t need the fast food any more. Now, I can make it semi-healthier. I can use the lighter bread; I don’t have to use a thick bun and all the condiments and the fries and the grease. So, I learned to keep better eating.”- Male PLWH “We try to go to the grocery store once a week unless I have something. The only thing we really would ever go for now would be like side dishes because we have hamburger, chickens, and all that stuff’s in our freezer, so if we run out of side dishes that’s the only time we would go out. We went out today and we hadn’t gone out for the past two weeks. So, it just depends on what we need.” – Male PLWH	Proposed long term sustainability for positive post-pandemic eating habits due to the positive health implications (i.e. weight loss) and savings of money associated with at home cooking. - Consider diet plans to assist individuals to consume healthy diets during time of limited grocery store access.
Restructured Physical Activity	The pandemic and related guidance prompted participants to engage in taking walks and other forms of exercise that are close to home in order to comply with CDC recommendations.	“attended a small group at the building, in a small room where I'd go and do the treadmill for my arthritis, and the heart failure thing, and that I had to discontinue because of the size of the room and I was not want to be clients who actually, I was not a priority. Yeah so that ended. So, basically I'm leading rather sedentary existence right now.”- Male PLWH	- Expand physical activity plans to incorporate activities that are home based such as walking outside and climbing stairs.
Faithfully Take Medication	Medication adherence remained a priority; even in the midst of a pandemic. Participants expressed control over taking their medications and some expressed how it helped their immune system to take their medication.	“I do not miss taking my medicine. I don't care what time it is but I didn't have this problem. I don't care what time it is. I'm always taking my medicine. I don't forget that I just started some vitamins. I went on and bought me some vitamins. I said maybe this will help me build some energies so. And I might forget and take that because I just started it. But my regular medicine, well see, I don't call it HIV medicine. I called my medicine lifetime.”- Female PLWH	- Continue to emphasize the importance of medication adherence (ART and CVD medications) on CVD health outcomes in PLWH.
Perseverance in Times of Difficulty	Ability to be resilient in order to maintain health (e.g. medication adherence, self-care and physical activity) due to their ongoing chronic condition of HIV.	“There really wasn’t one consistent before the pandemic. And since the pandemic, I became more consistent with three to five days of walking two to four miles. So, it actually increased or improved significantly since the pandemic.” – Male PLWH	- Harness healthy behaviors (i.e. healthy diet, physical activity, medication adherence and self-care) to promote CVD health outcomes.