AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #211 - Can traditional health practitioners address the structural drivers/factors of poor ART uptake and adherence in South Africa?
Authors: Presenting Author: Mr Gavin George - Health Economics and HIV/AIDS Research Division
Additional Authors: Prof. Jeff Gow, Mr. Khaled Ahmed,
Aim: Whilst access to treatment has greatly expanded, treatment coverage in low and middle-income countries is 36% as of 2010 (taking into account the new WHO guidelines). Two of the biggest challenges prohibiting the scale-up of treatment is widespread awareness of the value of testing and treatment and adequate health infrastructure, including health staff. Furthermore, high rates of attrition from treatment programmes poses a serious challenge to programme implementers and constitute an inefficient use of scarce treatment resources. This study examines Traditional Health Practitioners (THPs) interactions with potential HIV positive patients and illustrates how THPs could be potentially contributing to attrition or how they could become an untapped resource that can be ustilised to expand HIV and AIDS services. Currently, 80% of the indigenous South African population makes use of THP’s services, including HIV positive people and it is vital to determine whether this interaction supports or undermines the goal of universal access.
Method / Issue: A structured survey instrument was administered to a group of 186 THPs. Respondents’ practice activity and interaction with, and treatment of, HIV positive patients were explored. Recognised psychometric scales on knowledge and attitudes were used to measure knowledge of HIV transmission, prevention and symptoms of HIV.
Results / Comments: Almost half (45%) of THPs treated patients they suspect have HIV. Of concern, 39% believe there is a cure for AIDS, explaining their traditional medicine had made people better (62%) and their treatment worked well in conjunction with clinic-lead approaches (66%). 22% said their patients had stopped attending clinics since they began treating them. Of greatest concern is that half disagreed that an AIDS patients taking traditional medicine has no need for ART. These results presented indicate that knowledge and practices around HIV prevention are problematic. THPs exhibited a poor understanding of the transmission mechanisms of HIV and effective HIV prevention activities. Training in HIV and AIDS did not improve knowledge compared to their untrained colleagues. In contrast 93% agreed that anyone testing for HIV at a medical clinic was doing the right thing, whilst 86% were willing to support HIV counselling and testing (HCT) services and 65% would refer patients to a clinic for tests. This is very promising and suggests that THPs might be an under utilised resource in current efforts to increase testing numbers in South Africa.
Discussion: Practice activity was concerning, particularly around traditional medicinal treatment for AIDS. In cases where patients did attend clinics for treatment, dual use of traditional medicine may cause complications. Encouragement to abandon treatment by traditional doctors is also a concern. Whilst data exists to support the notion that THPs can play a role in HIV treatment, there is an urgent need to improve this training. With robust training, THPs can play a more meaningful role in HIV prevention and treatment activities and, equally importantly, in South Africa’s testing campaign. It is critical to bridge the gap between healers into the public healthcare system as THPs reach patients who would never make it to a doctor’s office. Traditional healers outnumber physicians by nearly 10 to 1, so potentially, well-trained healers can bring sound medical care to large unserved swaths of the population. To conclude, there exists both the opportunity to utilise THPs and the willingness from THPs to provide these services. It is imperative to ensure that THPs are adequately equipped to provide the services needed.
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