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

Abstract

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.

Perceptions and decision-making with regard to pregnancy among HIV positive women in rural Maputo Province, Mozambique – a qualitative study

“…This has been attributed to variant factors: discrimination, nondisclosure of HIV status, misinformation, drug shortage, stigma [19, 23, 24], lack of information about the importance of adhering to antiretroviral therapy [22], financial and social obstacles [20], and patients’ religious beliefs [25]. In Mozambique, for example, most patients seek a traditional healer before consulting a healthcare provider [26]. Such barriers arguably prevent couples from having a natural pregnancy with a minimal risk of infection among serodiscordant3 couples [27] and prevent passing on HIV to their infants [27, 28].…”

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

“…Within ART-based HIV programs, healers have demonstrably hindered the prompt provision of HIV services in some studies [2, 28] while showing little impact in others [29]. For PLHIV, the long-term effects of delayed, interrupted, or discontinued ART are severe, both due to rapid disease progression and the risk of transmission to sexual partners [30-34].…”

“…Patients who receive treatment from a traditional healer may be delayed in engaging allopathic services [28]. A diagnosis from a healer or TBA will typically result in weeks or even months of treatment; failure to resolve the problem can lead a patient to visit a different healer (thus further delaying testing or treatment) or lead to allopathic health seeking.…”

Southern Africa: the Highest Priority Region for HIV Prevention and Care Interventions

“…Hence, more effective partnerships between close to community health care workers (community health workers, traditional birth attendants, etc.) and traditional healers must be considered to facilitate referrals and establish a strong system of support for treatment adherence and other HIV care related issues [•15,23,24]. As providers and governments move toward expanded service and scale, retention in care proves to be one of the most important components.…”

“…Observations of transmission risk correlating with plasma and genital viral load have translated into HPTN 052 clinical trial evidence of efficacy of ART in the infected partner preventing transmission to the HIV-uninfected partner [•9,•25,28-31]. Shanaube and Bock highlight how TasP has increased focus on the need to provide access to medications in a timely manner without treatment interruption due to drug stockouts, services to enhance access to testing and retention in care, and attention to highly vulnerable key populations, including adolescent and young women, persons in serodiscordant relationships, men who have sex with men (MSM), sex workers, and people who inject drugs (PWID) [23]. …”