Lack of pre-antiretroviral care and competition from traditional healers, crucial risk factors for very late initiation of antiretroviral therapy for HIV - A case-control study from eastern Uganda

Abstract

BackgroundAlthough WHO recommends starting antiretroviral treatment at a CD4 count of 350 cells/[µ]L, many Ugandan districts still struggle with large proportions of clients initiating ART very late at CD4 < 50 cells/[µ]L. This study seeks to establish crucial risk factors for very late ART initiation in eastern Uganda.MethodsAll adult HIV-infected clients on ART in Iganga who enrolled between 2005 and 2009 were eligible for this case-control study. Clients who started ART at CD4 cell count of < 50 cells/[µ]L (very late initiators) were classified as cases and 50-200 cells/[µ]L (late initiators) as control subjects. A total of 152 cases and 202 controls were interviewed. Multivariate analyses were performed to calculate adjusted odds ratios and 95% confidence intervals.ResultsReported health system-related factors associated with very late ART initiation were stock-outs of antiretroviral drugs stock-outs (affecting 70% of the cases and none of the controls), competition from traditional/spiritual healers (AOR 7.8, 95 CI% 3.7-16.4), and lack of pre-ARV care (AOR 4.6, 95% CI: 2.3-9.3). Men were 60% more likely and subsistence farmers six times more likely (AOR 6.3, 95% CI: 3.1-13.0) to initiate ART very late. Lack of family support tripled the risk of initiating ART very late (AOR 3.3, 95% CI: 1.6-6.6).ConclusionPolicy makers should prevent ARV stock-outs though effective ARV procurement and supply chain management. New HIV clients should seek pre-ARV care for routine monitoring and determination of ART eligibility. ART services should be more affordable, accessible and user-friendly to make them more attractive than traditional healers

Treatment interruption in HIV‐positive patients followed up in Cameroon's antiretroviral treatment programme: individual and health care supply‐related factors (ANRS‐12288 EVOLCam survey)

“…As with any chronic disease, our results suggest that a relationship of trust between health care providers and patients is essential for the continuity of care and treatment . Consulting traditional healers has also been reported in several studies: it may represent a more accessible and cheaper alternative to academic medicine, but may also reflect a desire to distance oneself from modern medicine .…”

“…They emphasise the importance of patients' social contexts and their experience with care. The lower risk of TI>2d in PLWH living in a couple (compared with those having a main partner but living separately) suggests that such a relationship is probably associated with HIV disclosure and mutual support [17,[38][39][40][41][42]. Furthermore, PLWH, unsatisfied with the attention their doctor provided, were more likely to interrupt their treatment as were those who had consulted a traditional healer during the previous 3 months.…”

“…Consulting traditional healers has also been reported in several studies: it may represent a more accessible and cheaper alternative to academic medicine, but may also reflect a desire to distance oneself from modern medicine [24,32,41,45].…”

Medical Pluralism Predicts Non-ART Use among Parents in Need of ART: A Community Survey in KwaZulu-Natal, South Africa

“…This might be explained by delayed HIV testing 12 or ART dropout resulting from conflict between traditional and clinic treatment advice 33 . However, the mixed state of quantitative evidence on the relationship between medical pluralism and ART uptake 15 , 16 mandates further research before firm inferences can be made.…”

“…A case-control study in a Ugandan ART clinic found that those who sought care from traditional/spiritual healers before coming to the clinic were more likely to have late ART initiation (CD4 < 50 cells/µL) than individuals who did not report seeking care from traditional/spiritual healers 15 . Conversely, another Ugandan study of 450 ART patients found that seeking care from traditional healers/spiritual healers was not significantly associated with lower CD4 counts at ART initiation 16 , suggesting that use of traditional healers did not delay ART initiation.…”