Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial

Sundararajan, Radhika; Ponticiello, Matthew; Lee, Myung Hee; Strathdee, Steffanie A.; Muyindike, Winnie; Nansera, Denis; King, Rachel; Fitzgerald, Daniel W.; Mwanga-Amumpaire, Juliet

doi:10.1016/s2214-109x(21)00366-1

Cited by 22 publications

(16 citation statements)

References 24 publications

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“…In many cases, traditional healers may be preferred as they are more accessible in communities compared with biomedical healthcare facilities, where HIV clinical treatment facilities carry stigma [50]. We and others have also shown that patients choose to receive care from traditional healers instead of medical clinics due to trusting relationships with healers and the perception that healers provide more psychosocial support [34,36,[52][53][54]. Modern medicine has also been criticized for failing to resolve all health problems, and thus, traditional medicine promises to fill the void in the biomedicine health care system [51].…”

Section: Discussionmentioning

confidence: 99%

“…The improved quality of life has been attributed to traditional healers' provision of psychosocial support and a familiar cultural context for healthcare delivery [33]. We, and others, have shown that when trained by healthcare professionals, traditional healers are both willing and able to facilitate HIV testing among their clients [34][35][36].…”

Section: Introductionmentioning

confidence: 99%

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

Matungwa

Hong

Jeremiah

et al. 2022

PLOS Glob Public Health

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Tanzania is HIV-endemic, with 5% prevalence. However, less than half of Tanzanians are aware of their HIV status, and only 75% of adult Tanzanians living with HIV are on antiretroviral therapy (ART). Informal healthcare providers, such as traditional healers, frequently serve as the first line of healthcare in Tanzania. How traditional healers interact with people living with HIV (PLWH) remains unknown. This study sought to understand gaps in HIV care and explore how traditional healers interface with PLWH along the HIV care cascade. We conducted a qualitative study in Mwanza, Tanzania, between November 2019 and May 2020. We invited 15 traditional healers, 15 clients of traditional healers, 15 biomedical healthcare facility staff, and 15 PLWH to participate in a single qualitative interview. Two community focus groups were held with eight male and eight female participants. Participants were 18 years of age or older. Individual experiences with traditional healers and biomedical healthcare facilities, as well as perceptions of traditional healers with respect to HIV care, were explored through interviews. Using a content-analysis approach, codes were grouped into a framework that characterized how traditional healers engage with PLWH throughout the HIV care cascade. PLWH engaged with traditional healers throughout the HIV care cascade, from pre- to post-HIV diagnosis. Traditional healers were described in some cases as facilitating HIV testing, while others were described as delaying testing by providing traditional treatments for HIV symptoms. Traditional medications were frequently used concurrently with ARTs by PLWH. There was concern that healers contributed to ART nonadherence as some PLWH used traditional therapies in search of a “cure” for HIV. Our findings suggest that traditional healers interact with PLWH throughout the HIV care continuum and that collaboration between traditional healers and biomedical healthcare professionals and facilities is needed to improve HIV treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Matungwa

Hong

Jeremiah

et al. 2022

PLOS Glob Public Health

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“…Prospective intervention designs could consider engaging with traditional healers or educating traditional healers to improve adherence for people with hypertension in communities where concurrent traditional medicine use is common. Previous studies [46][47][48][49][50] demonstrate that partnerships with traditional healers can improve health education for chronic diseases.…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Understanding barriers and facilitators to clinic attendance and medication adherence among adults with hypertensive urgency in Tanzania

Kisigo

Mcharo

Robert

et al. 2022

PLOS Glob Public Health

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Hypertensive urgency is a major risk factor for cardiovascular events and premature deaths. Lack of medication adherence is associated with poor health outcomes among patients with hypertensive urgency in resource-limited settings. To inform the development of tailored interventions to improve health outcomes in this population, this study aimed at understanding facilitators and barriers to clinic attendance and medication adherence among Tanzanian adults with hypertensive urgency. We conducted in-depth interviews with 38 purposively selected participants from three groups: 1) patients with hypertension attending hypertension clinic, 2) patients with hypertension not attending hypertension clinic, and 3) clinic health workers. Interviews were conducted using a semi-structured guide which included open-ended questions with prompts to encourage detailed responses. In their narrative, patients and healthcare workers discussed 21 types of barriers/facilitators to clinic attendance and medication adherence: 12 common to both behaviors (traditional medicine, knowledge and awareness, stigma, social support, insurance, reminder cues, symptoms, self-efficacy, peer support, specialized care, social services, religious beliefs); 6 distinct to clinic attendance (transport, clinic location, appointment, patient-provider interaction, service fragmentation, quality of care); and 3 distinct to medication adherence (drug stock, side effects, medicine beliefs). The majority of identified barriers/facilitators overlap between clinic attendance and medication adherence. The identified barriers may be surmountable using tailored supportive intervention approaches, such as peer counselors, to help patients overcome social challenges of clinic attendance and medication adherence.

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“…It is estimated that 80% of the population in South Africa seek healthcare from traditional healers [10]. Due to their ubiquity in sSA, there is growing interest in the role and integration of traditional healers into clinical pathways, and a recent randomized controlled trial has demonstrated significant improvements in point-of-care HIV testing with integration of traditional healers in Uganda [11]. From the surgical perspective, a recognition that patients may have already tried multiple treatment attempts prior to or alongside seeking formal urological care, is pertinent to the patient history and treatment plan.…”

Section: Fournier's Gangrenementioning

confidence: 99%

Understanding cultural and logistical contexts for urologists in low‐income countries

et al. 2022

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The provision of effective urological management in low-and middle-income countries requires the delivery of appropriate and effective care adapted to the needs, capability and resources of the host country. However, a deeper cognisance of the culture, the religious practices and the logistics of healthcare in that environment determines the ability to effectively to 'twin', that is, to provide a long-term healthcare partnership. Patient beliefs can have profound effects on the understanding of the aetiology of illness, its relevance to their long-term health and the stigmatization of their family's social status. Consequently, individuals may have a greater willingness to seek help from practitioners of traditional medicine due to its availability as well as the lower costs of such medicine by comparison to those of medicine from highincome countries (HICs). This can influence the treatment of many urological conditions and lead to late-presenting states such as malignant ureteric obstruction. Social mores, such as cultural paternalism, can also influence many practices that are assumed by HICs to be part of normal healthcare provision, including the delivery of patient information and provision of informed consent to treatment. Doctor's status and dress have greater importance in many countries in sub-Saharan Africa (sSA) than in the UK and the modes of greeting and addressing colleagues and patients can affect the fluency and effectiveness of clinical interactions. A local cultural and religious knowledge is essential, therefore, to optimize the assimilation of external help. Logistics are perhaps the most important factor that needs to be grasped to provide a sustainable healthcare environment. Limitations in resource allocation are a major factor in planning effective urological treatment in many countries in sSA, whether this is the provision of trained personnel, basic infrastructure, a tenable workspace, equipment or drugs. This paper explores all of these factors, and looks at how their recognition assists urologists in providing a twinning process.

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Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial

Cited by 22 publications

References 24 publications

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

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

Understanding barriers and facilitators to clinic attendance and medication adherence among adults with hypertensive urgency in Tanzania

Understanding cultural and logistical contexts for urologists in low‐income countries

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