Partnering with traditional healers boosts HIV testing in Uganda

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Prisca Asimwe, a nurse at the Mbarara Community Referral Hospital (second from right), is instructing traditional therapists on the use of rapid HIV testing with oral swabs. Credits: Radhika Sundararajan / Cornell University

According to a study by researchers at Weill Cornell Medicine and Mbarara University of Science and Technology, we work with traditional therapists to provide point-of-care HIV tests to rural individuals in Uganda with standard referrals to HIV clinics. In comparison, the inspection rate has quadrupled.

Healer-provided HIV testing models have the potential to significantly improve the spread of HIV testing and improve the proportion of connections to HIV care among hard-to-reach people in sub-Saharan Africa’s HIV-endemic areas. I have it.

The study was published on October 19th Lancet Global HealthShowed 100% test uptake among the 250 participants in the HIV testing group provided by traditional therapists, compared to 23% of the 250 participants in the referral group. Ten people in the intervention group were virus-positive, seven of whom were followed up and started antiretroviral treatment within 90 days. No new HIV cases were identified in the referral group.

The overall HIV positive rate in Uganda is close to 6%, and in the southwest it is close to 8%. Testing, counseling, and early treatment are essential to control the epidemic. However, despite international efforts to increase test rates through reaching mobile clinics, home visits by healthcare professionals, and community distribution of self-test kits, test rates remain low. For example, the Ministry of Health of Uganda recommends annual testing, but studies show that in rural Uganda, about 80% of sexually active men were not infected with HIV. test In the last 12 months.

“Previous methods of delivering HIV testing to the community relied on creating new delivery channels that were logically complex, costly and difficult to maintain,” said the Global Health Center, an assistant professor of emergency medicine. Said Dr. Radika Sandara Rajan, a faculty member of the. In Weil Cornell Medicine. “Getting a traditional healer to provide a point of care HIV test directly to a patient has been successful, partly because it reflects the patient’s preference for care rather than the clinic.”

Many people in sub-Saharan rural areas use traditional healers for medical care more often than in clinics. Ugandan healers have four specialists: herbalists, spiritualists, midwives, and osteopaths. However, studies by others have shown that relying on healers to refer individuals to the clinic for HIV testing is ineffective.

The team hired 17 traditional healers from all four disciplines from Mubarara Township, a rural agricultural area in southwestern Uganda, for a cluster randomization trial. Healers have been randomized to provide either oral swab HIV testing or referrals to the clinic for HIV testing.

Dr. Denis Nansera, a Ugandan infectious disease doctor and clinical director of the Mbarara District HIV Clinic, said HIV infection, symptoms, prevention, treatment and HIV testing guidelines of the Ugandan Ministry of Health. The next day, a healer from the intervention group was invited to learn how to safely perform an oral swab HIV test and provide post-test counseling to clients.

In an interview with Exit, participants in a test group provided by the healer said that traditional healers are more reliable, confidential, and easier to access than clinics. Barriers to test uptake reported by referral groups included 8-10 hours of waiting time in the clinic, lack of access to transportation, high transportation costs, and the risk of positive tests.

“This is the best global health. Doctors who understand how to diagnose and treat HIV in conjunction with traditional HIV. Healer We understand the community and we understand that we provide fair access to health care for everyone. “

This study is the result of three years of shaping work by Weil Cornell medical researchers in the countryside of Uganda, in collaboration with colleagues at the Mbarara Regional Referral Hospital in Uganda and the Mbarara University of Science and Technology. University of California, San Diego. University of California, San Francisco.

“It’s very rewarding to see patients come to the clinic for life-saving treatment,” said Sundararajan. “Testing more people is a starting point for identifying those who need to be associated with effective treatment and HIV care.”


Studies show that traditional healers contribute to delays in HIV care


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Cornell University

Quote: Partnering with a traditional healer will facilitate HIV testing in Uganda (October 21, 2021).

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