Healer-led vs. clinician-led training to improve personal protective equipment use among traditional healers in South Africa: a randomized controlled trial protocol

Abstract

There are estimated two million traditional healers in sub-Saharan Africa (SSA), with more than 10% (200,000) working in South Africa. Traditional healers in SSA are frequently exposed to bloodborne pathogens through the widespread practice of traditional ‘injections’, in which the healers perform dozens of subcutaneous incisions to rub herbs directly into the bloodied tissue with their hands. Healers who report exposure to patient blood have a 2.2-fold higher risk of being HIV-positive than those who do not report exposure. We propose a randomized controlled trial (61 healers in the intervention group and 61 healers in the control group) in Mpumalanga Province. Healers will receive personal protective equipment (PPE) education and training, general HIV prevention education, and three educational outreach visits at the healer’s place of practice to provide advice and support for PPE use and disposal. Healers in the control arm will be trained by health care providers, while participants in the intervention arm will receive training and outreach from a team of healers who were early adopters of PPE. We will evaluate intervention implementation using data from surveys, observation, and educational assessments. Implementation outcomes of interest include acceptability and feasibility of PPE use during clinical encounters and fidelity of PPE use during treatments that involve blood exposure. We will test our two intervention strategies to identify an optimal strategy for PPE education in a region with high HIV prevalence.

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

“…Traditional healers are prone to contracting HIV when performing traditional healing because of the incisions they make in the people they are treating, combined with the fact that most of them do not use PPE such as gloves and goggles, as they believe these to be too expensive. The same narrative was shared by Audet et al 2 that traditional healers are aware that there are risks associated with exposure during invasive procedures, but that few purchase PPE or use it correctly because it is expensive, and they cannot afford it. If they do not have gloves, they improvise by using a small stick to apply the medicines to the cuts to ensure that there is no touching of the blood with their bare hands.…”

“…15 When a woman loses a child or suffers abortion, both parents' blood are mixed through an incision on the umbilicus, in order not to lose a child or to abort subsequent pregnancies. Audet et al 2 supports this, stating that a widespread practice is the traditional 'injection' (described as such by traditional healers, although the wounds could more accurately be described as incisions), in which the healer performs dozens of subcutaneous incisions to rub herbs directly into the bloodied skin.…”

“…A lack of training as well as the improper use and donning of personal protective equipment (PPE) increase the risk of traditional healers contracting HIV when in contact with bodily fluids whilst treating patients living with HIV. This statement was attested by other researchers, 2 who stated that the low ratio of traditional healers trained on the use of PPE (gloves, safety glasses, facemasks, respirators) put them at risk of contracting and spreading HIV. In South Africa, one of the sub-Saharan countries where HIV prevalence has increased sharply from 13.1% in 2018 to 13.7% in 2021, and where 8.2% of people were estimated to be living with HIV in 2021, 5 the role of traditional healing is paramount in addressing HIV and reducing AIDS-related deaths.…”

“…In rural South Africa, traditional healers provide physical and psychological services to > 80% of the population. 2 People seek hospital care only when they are seriously ill. This means that medical care is not sought early in the course of the disease, and this negatively impacts the treatment of HIV and AIDS.…”

“…Traditional healers are also exposed to bodily fluids, including blood, when making incisions in the treatment of their clients, and this exposes them to HIV infection. Evidence from a study 2 in South Africa established that traditional healers are exposed to patients’ blood and bodily fluids and that this puts them at risk of contracting HIV whilst treating their clients.…”