Shortening “the Road” to Improve Engagement with HIV Testing Resources: A Qualitative Study Among Stakeholders in Rural Uganda

Abstract

In HIV-endemic areas, traditional healers are frequently used with, or instead of, biomedical resources for health care needs. Studies show healers are interested in and capable of supporting patients in the HIV care cascade. However, adults who receive care from healers have low engagement with HIV services. To achieve epidemic control, we must understand gaps between the needs of HIV-endemic communities and the potential for healers to improve HIV service uptake. This study's objective was to characterize stakeholder perspectives on barriers to HIV testing and approaches to mitigate barriers in a medically pluralistic, HIV-endemic region. This study was conducted in Mbarara District, a rural area of southwestern Uganda with high HIV prevalence. Participants included HIV clinical staff, traditional healers, and adults receiving care from healers. Fifty-six participants [ N = 30 females (52%), median age 40 years (interquartile range, 32–51.5)] were recruited across three stakeholder groups for minimally structured interviews. Themes were identified using an inductive, grounded theory approach and linked together to create a framework explaining stakeholder perspectives on HIV testing. Stakeholders described the “road” to HIV testing as time-consuming, expensive, and stigmatizing. All agreed healers could mitigate barriers by delivering HIV testing at their practices. Collaborations between biomedical and traditional providers were considered essential to a successful healer-delivered HIV testing program. This work describes a novel approach to “shorten the road” to HIV testing, suggesting that traditional healer-delivered HIV testing holds promise to expand uptake of testing among communities with limited access to existing programs.

The effects of traditional healing on HIV and AIDS management: An ethnographic study

“…Due to the traditional nature of the district, most Vhavenda people frequent traditional healers as their first point of care. Other researchers 3 share the same sentiment that people do not believe in Western medicine. They would rather go to a traditional healer than waste time coming to the health facility.…”

“…Using traditional healers has been associated with delays in HIV diagnoses and also lead to reduced antiretroviral (ARV) adherence amongst people living with HIV. 3 Traditional healers believe that there is no HIV, and this impacts negatively on the management of HIV as they end up influencing their clients to believe that they can heal them. Contrary to these findings, is the study 4 conducted in Bangladesh, which revealed that the Kabiraji traditional healers in Bhabanipur and Jobra villages believe that they have healed many diseases, including HIV.…”

How informal healthcare providers improve uptake of HIV testing: qualitative results from a randomized controlled trial

“…Prior research from rural Mozambique showed that many PWH utilize traditional healers, and that visiting a traditional healer exponentially prolongs time to HIV diagnosis [32]. Some have suggested that traditional healers might be able to improve uptake of HIV services among their clients [33][34][35][36].…”

Understanding the role of traditional healers in the HIV care cascade: Findings from a qualitative study among stakeholders in Mwanza, Tanzania

“…Traditional healers have been proposed as a community-based strategy for enhancing the HIV care cascade [14,15]. Collaboration with traditional healers could be particularly impactful in sub-Saharan Africa where the WHO estimates that 80% of the population seeks their services on a regular basis [16].…”