How informal healthcare providers improve uptake of HIV testing: qualitative results from a randomized controlled trial

Abstract

Objective: Uganda is HIV-endemic with a prevalence of 5.7%. Lack of epidemic control has been attributed to low engagement with HIV testing. Collaborating with informal healthcare providers, such as traditional healers, has been proposed as a strategy to increase testing uptake. We explored acceptability and implementation of an HIV testing program where traditional healers delivered point-of-care testing and counseling to adults of unknown serostatus (clinicaltrials.gov NCT#03718871).Methods: This study was conducted in rural, southwestern Uganda. We interviewed participating traditional healers (N ¼ 17) and a purposive sample of trial participants (N ¼ 107). Healers were practicing within 10 km of Mbarara township, and 18þ years old. Participants were 18þ years old; sexually active; had received care from participating healers; self-reported not receiving an HIV test in prior 12 months; and not previously diagnosed with HIV infection. Interviews explored perceptions of a healer-delivered HIV testing model and were analyzed following a contentanalysis approach.Results: Most participants were female individuals (N ¼ 68, 55%). Healer-delivered HIV testing overcame structural barriers, such as underlying poverty and rural locations that limited use, as transportation was costly and often prohibitive. Additionally, healers were located in villages and communities, which made services more accessible compared with facility-based testing. Participants also considered healers trustworthy and 'confidential'. These qualities explain some preference for healer-delivered HIV testing, in contrast to 'stigmatizing' biomedical settings. Conclusion:Traditional healer-delivered HIV testing was considered more confidential and easily accessible compared with clinic-based testing. Offering services through traditional healers may improve uptake of HIV testing services in rural, medically pluralistic communities.

Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid effectiveness-implementation trial

“…While there is observational evidence suggesting that TH can be leveraged as lay providers to improve engagement in HIV care, there is a dearth of systematic trials addressing this subject [ 34 , 39 , 74 – 76 ]. This clinical trial is essential for definitively evaluating the impact of TH-supported care on HIV suppression in rural communities and optimizing the allocation of programmatic resources to low-income contexts.…”

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

“…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].…”

Adaption and pilot testing of a lay HIV supporter program for traditional healers: a mixed methods study in rural Uganda

“…TH are informal healthcare providers and trusted community members who may be uniquely positioned to bridge the rural HIV treatment gap. Qualitative data from multiple countries suggest that TH are among the most accessible and trusted providers in rural communities, where the majority of Africans reside [ 7 – 12 ]. TH often serve as the first line of healthcare for rural PLWH, some of whom prefer healers’ care alone, and some of whom utilize both TH and clinic-based care [ 13 – 16 ].…”