Drug interactions in African herbal remedies

Cordier, Werner; Steenkamp, Vanessa

doi:10.1515/dmdi.2011.011

Cited by 23 publications

(16 citation statements)

References 103 publications

(148 reference statements)

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“…The role of these healers in promoting HIV care utilization can be negative (promoting delays and discontinuation of care [27, 28]) or positive (strong advocates for patient health [29, 30]). A lack of HIV/ART knowledge, positive beliefs about HIV care, and skills to motivate individuals to access and remain in HIV care limit the potential positive influence of traditional healers [31–35]. Thus, we believed the development of a program focusing on the delivery of quality HIV care promotion, education, and counseling from in-community traditional healers required careful efforts to build trust and strong working relationships between care sites and traditional healers, provide HIV treatment and counseling training for healers, and establish clear guidelines as to the roles healers would play in the treatment of PLHIV.…”

Section: Introductionmentioning

confidence: 99%

Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique

et al. 2017

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BackgroundSystematic adaptation of evidence-informed interventions that increase retention in care and improve adherence to antiretroviral therapy (ART) are essential to ending the HIV epidemic in rural sub-Saharan Africa. We selected and adapted an adherence support worker intervention employed in Malawi for use by traditional healers in rural Mozambique. Given the levels of trust and dependence previously expressed by persons living with HIV (PLHIV) for traditional medicine, we adapted the program to engage traditional healers within the allopathic health system.MethodsAdaption followed a theoretically driven approach to intervention adaption: the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) model. Three rounds of performance feedback, based on theater presentations of the adapted intervention for stakeholders and idea generation, were completed with 12 groups from March to July 2016 to develop the final model. We offered healer support to 180 newly diagnosed HIV-infected patients.ResultsTraditional healers were an acceptable group of community health workers to assist with patient adherence and retention. Traditional healers, clinicians, and interested community members suggested novel strategies to tailor the adherence support worker intervention, revealing a local culture of HIV denialism, aversion to the health system, and dislike of healthcare providers, as well as a preference for traditional treatments. Proposed changes to the intervention included modifications to the training language and topics, expanded community-based activities to support acceptability of an HIV diagnosis and to facilitate partner disclosure, and accompaniment to the health facility by healers to encourage delivery of respectful clinical care. PLHIV, healers, and clinicians deemed the intervention socially acceptable during focus groups. We subsequently recruited 180 newly diagnosed HIV-infected patients into the program: 170 (94%) accepted.ConclusionsSystematic translation of interventions, even between regions with similar social and economic environments, is an important first step to successful program implementation. Efforts previously limited to community health workers can be tailored for use by traditional healers—an underutilized and often maligned health workforce. It proved feasible to use theater-based performances to demonstrate delivery of the intervention in low-literacy populations, generating discussions about social norms, community concerns, and the merits of an acceptable strategy to improve retention and adherence to ART.

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Section: Introductionmentioning

confidence: 99%

Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique

et al. 2017

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“…With retention rates below 60% in some regions [40-42], factors for loss to follow up include: male gender, WHO clinical stage IV, low BMI, heavy alcohol consumption, stigma, health service delivery issues, and a preference for alternative health practitioners [43]. The occurrence of healers “poaching” unsatisfied HIV-infected patients, health consequences of patients bouncing back and forth between the two systems, and impact of herbal remedies on viral suppression is underexplored [44]. These data are difficult to capture for several reasons: (1) it can be difficult to locate patients who have abandoned care; (2) patients may be unwilling (or unable) to disclose the exact herb name and dosage of alternative treatments they are receiving [45, 46]; and (3) healers are often suspicious of revealing the treatments they provide, fearing the allopathic system will steal it without compensation [3, 47].…”

Section: Introductionmentioning

confidence: 99%

“…Despite interest in assisting PLHIV, healers often lack ART/HIV knowledge and awareness of herb-ART interactions [8, 44-47]. Fundamental differences in disease causation beliefs can make it difficult for clinicians and traditional practitioners to communicate effectively and agree on a course of action.…”

Section: Introductionmentioning

confidence: 99%

“…By engaging healers, there is concern that healer engagement is harmful through co-administration of potentially hepato- and/or nephrotoxic agents with deleterious drug-ART interactions [3, 4, 8, 44-47, 51]. For example, Hypoxoside , specifically H. hemerocallidea and H. colchicifolia are popular herbal remedies in SSA used as immunostimulants for PLHIV [47].…”

Section: Introductionmentioning

confidence: 99%

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Engagement of Traditional Healers and Birth Attendants as a Controversial Proposal to Extend the HIV Health Workforce

et al. 2015

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“Medical pluralism” is the use of multiple health systems and is common among people living with HIV/AIDS in sub Saharan Africa. Healers and traditional birth attendants (TBAs) often are a patient's first and/or preferred line of treatment; this often results in delayed, interrupted, or abandoned diagnosis and therapy. Literature from the study of medical pluralism suggests that HIV care and treatment programs are infrequently and inconsistently engaging healers around the world. Mistrust and misunderstanding among patients, clinical providers, and traditional practitioners make the development of effective partnerships difficult, particularly regarding early HIV diagnosis and antiretroviral therapy. We provide recommendations for the development of successful collaboration health workforce efforts based on both published articles and case studies from our work in rural Mozambique.

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“…Future research in this area is required to ensure that healer treatments do not encourage the co-administration of potentially hepato- and/or nephrotoxic agents or result in additional possible deleterious drug-herb interactions. 34–38 …”

Section: Discussionmentioning

confidence: 99%

Symptomatic HIV-Positive Persons in Rural Mozambique Who First Consult a Traditional Healer Have Delays in HIV Testing

Audet

Blevins

Rosenberg

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Delays in HIV diagnosis and initiation of antiretroviral therapy (ART) are common even among symptomatic individuals in Africa. We hypothesized that ART delays might be more common if traditional healers were the first practitioners consulted. Design Cross-sectional study Methods We interviewed 530 newly diagnosed HIV-infected adults (≥18 years of age) who were clinically symptomatic at the time of HIV testing in two rural districts in Zambézia Province, Mozambique. We ascertained their prior health care seeking behavior, duration of their symptoms, CD4+ cell counts at the time of entry into care, and treatment provided by traditional healer(s). Results Of 517 patients (97.5%) with complete histories, 62% sought care from a healer before presenting to the local health facility. The median time to first health facility visit from first relevant symptom was 2 months (interquartile range [IQR]:1–4.5) for persons who had not visited a healer, 3 months [IQR:2–6] for persons visiting one healer, and 9 months [IQR: 5–12] for persons visiting >1 healer (p<0.001). Healers diagnosed 56% of patients with a social or ancestral curse and treated 66% with subcutaneous herbal remedies. A non-significant trend towards lower CD4+ cells for persons who had seen multiple healers was noted. Conclusion Seeking initial care from healers was associated with delays in HIV testing among symptomatic HIV-seropositive persons. We had no CD4 evidence that sicker patients bypass traditional healers, a potential inferential bias. Engaging traditional healers in a therapeutic alliance may facilitate the earlier diagnosis of HIV/AIDS.

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Drug interactions in African herbal remedies

Cited by 23 publications

References 103 publications

Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique

Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique

Engagement of Traditional Healers and Birth Attendants as a Controversial Proposal to Extend the HIV Health Workforce

Symptomatic HIV-Positive Persons in Rural Mozambique Who First Consult a Traditional Healer Have Delays in HIV Testing

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