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Mosavat SH, Pasalar M, Joulaei H, Ameli V, Heydari ST, Mirzazadeh A, Hashempur MH. Complementary and alternative medicine use among people living with HIV in Shiraz, Southern Iran. Front Public Health 2023; 11:1206665. [PMID: 37869188 PMCID: PMC10585019 DOI: 10.3389/fpubh.2023.1206665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background Living with HIV requires lifelong care to support engagement with and adherence to antiretroviral therapy. The Middle East and North Africa region provides access to ART, but research is lacking on the lived-experiences of people living with HIV. Globally, complementary and alternative medicine (CAM) is increasingly used by patients who need support alongside receiving medical treatment for chronic conditions. This study aims to examine the frequency and reasons behind the use of CAM, as well as identify its associated factors among people living with HIV in Shiraz, Iran. Methods In this cross-sectional study, a total of 320 patients (aged 18-70 years) with a confirmed diagnosis of HIV residing in Fars province and diagnosed between 1999 and 2019 were recruited randomly through their clinical record numbers from five HIV treatment centers. They were surveyed on their quality of life and CAM use via the Short-Form Health Survey questionnaire (SF-36) and a semi-structured survey of "CAM use." The data analysis for this study involved the use of Chi-squared test, independent t-test, and multiple logistic regression model. Results Of 287 patients, 89.22% reported using CAM in the previous year. CAM use was more prevalent among those with a family history of CAM use (94.3% vs. 81.8%, p = 0.023). Frequent reasons for using CAM were reported to be sexual dysfunction (32.4%), depression (28.3%), thirstiness (23.3%), and nausea (17.5%). Quality of life, as measured via the SF-36 questionnaire in all its 8 sub-domains, did not differ among those who used CAM versus those who did not (61.5 ± 27.6 vs. 58.1 ± 30.9, p = 0.626). Conclusion CAM was used among a majority of people living with HIV in Shiraz, Iran. People who used CAM appeared to experience a similar quality of life relative to those who did not use CAM. Future studies on the modalities of engagement with CAM can improve patient-physician shared decision-making and increase lifelong care options for people living with HIV.
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Affiliation(s)
- Seyed Hamdollah Mosavat
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vira Ameli
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Ramirez Garcia MP, Leclerc-Loiselle J, Côté J, Brouillette MJ, Thomas R. The process of learning the autogenic training relaxation technique and its benefits on the wellness of people living with HIV. BMC Complement Med Ther 2022; 22:86. [PMID: 35331226 PMCID: PMC8953141 DOI: 10.1186/s12906-022-03557-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background Various mind-body practices are used by people living with HIV to promote their general well-being. Among these is autogenic training (AT), a self-guided relaxation technique requiring regular practice for observable benefits. However, little has been written about the process of learning this technique, which is obviously a prerequisite to regular practice. This study therefore aims to describe the process by which people living with HIV learn AT. Methods The study is a descriptive qualitative study using semi-structured interviews and a thematic analysis with a mixed approach. Fourteen participants living with HIV completed sessions to learn autogenic training over a period of 3 months. Results The process of learning AT was approached through three themes: initiating the learning process, taking ownership of the technique, and observing its benefits on wellness. To initiate learning, participants had to express a need to take action on an aspect of their well-being and their openness to complementary approaches to care. Taking ownership of the technique was facilitated by guidance from the nurse researcher, the participants’ personal adaptations to overcome barriers to their practice, regular practice, and rapid observation of its benefits. Finally, the participants reported the observation of benefits on their wellness, including personal development, mainly in terms of the creative self, the essential self, and the coping self. This perception of the technique’s benefits was part of the learning process, as it contributed both to the participants’ ownership of the technique and to reinforcing their AT practice. Conclusions People living with HIV see learning AT as a progressive process, in which wellness is a major outcome and a contributing factor in developing a regular practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03557-6.
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Affiliation(s)
- Maria Pilar Ramirez Garcia
- Faculty of Nursing, Université de Montréal, P. 6128, succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada. .,Research Center of the Centre Hospitalier de l'Université de Montréal, P. 6128, succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada. .,Quebec Nursing Intervention Research Network (RRISIQ), Quebec, QC, Canada.
| | - Jérôme Leclerc-Loiselle
- Faculty of Nursing, Université de Montréal, P. 6128, succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada
| | - José Côté
- Faculty of Nursing, Université de Montréal, P. 6128, succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, P. 6128, succ. Centre-Ville, Montréal, QC, H3C 3J7, Canada.,Quebec Nursing Intervention Research Network (RRISIQ), Quebec, QC, Canada
| | - Marie-Josée Brouillette
- Department of Psychiatry, McGill University, Montréal, QC, Canada.,AIDS and Infectious Disease Network (SIDA-MI), Quebec, Canada
| | - Réjean Thomas
- AIDS and Infectious Disease Network (SIDA-MI), Quebec, Canada.,Clinique médicale l'Actuel, Montréal, Québec, Canada
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Sy KTL, Tariq S, Ramjee G, Blanchard K, Leu CS, Kelvin EA, Exner TM, Gandhi AD, Lince-Deroche N, Mantell JE, O’Sullivan LF, Hoffman S. Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study. PLoS One 2021; 16:e0246744. [PMID: 33606712 PMCID: PMC7895397 DOI: 10.1371/journal.pone.0246744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010-2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19-0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01-1.07) and higher CD4+ cell count (≥300μL vs. <150μL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19-0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.
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Affiliation(s)
- Karla Therese L. Sy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Shema Tariq
- Institute for Global Health, University College London, London, United Kingdom
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, Massachusetts and Johannesburg, South Africa
| | - Cheng-Shiun Leu
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Elizabeth A. Kelvin
- Department of Epidemiology & Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America
| | - Theresa M. Exner
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Anisha D. Gandhi
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Cambridge, Massachusetts and Johannesburg, South Africa
| | - Joanne E. Mantell
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
| | | | - Susie Hoffman
- Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Jiang T, Hou J, Sun R, Dai L, Wang W, Wu H, Zhang T, Su B. Immunological and Psychological Efficacy of Meditation/Yoga Intervention Among People Living With HIV (PLWH): A Systematic Review and Meta-analyses of 19 Randomized Controlled Trials. Ann Behav Med 2020; 55:505-519. [PMID: 33119732 DOI: 10.1093/abm/kaaa084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An expanding number of mind-body therapies are being used to reduce the psychological burden of peoples living with human immunodeficiency virus (HIV). However, the effects on the immune system and mental health varied among studies. PURPOSE This meta-analysis was conducted to summarize the randomized controlled trials to draw comprehensive conclusions regarding the psycho-immunological efficacy. METHODS Random-effects models were used to assess the outcome of interest. Egger's tests were used to identify publication bias. Subgroup and meta-regression were used to explore potential moderators. This review was registered on the PROSPERO database (CRD42019148118). RESULTS Nineteen randomized controlled trials with a total sample size of 1,300 were included in this meta-analysis. Regarding immune system outcome, mind-body therapy significantly improved CD4 T-cell counts (Cohen's d = 0.214, p = .027) and maintained (0.427, p = .049). In addition, baseline CD4 T-cell counts and years since HIV diagnosis significantly moderated the efficacy of mind-body practices on CD4 improvement (all ps < .001). Regarding mental health outcome, mind-body therapy significantly reduced stress, depression, and anxiety symptoms (0.422, p < .001; 0.506, p < .001, and 0.709, p < .001, respectively) while improving quality of life (0.67, p < .001). CONCLUSIONS Meditation/yoga intervention could result in potential benefits with regard to improved CD4 T-cell counts immediately after the intervention and at long-term follow-up, while also improving their mental health. The cost-effective meditation/yoga intervention should be integrated into routine care for people living with HIV, especially for those with lower CD4 baseline and fewer years since diagnosis.
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Affiliation(s)
- Taiyi Jiang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Runsong Sun
- Department of Sociology and Social Work, School of Sociology, Beijing Normal University, Beijing, China
| | - Lili Dai
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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Sundararajan R, Mwanga-Amumpaire J, King R, Ware NC. Conceptual model for pluralistic healthcare behaviour: results from a qualitative study in southwestern Uganda. BMJ Open 2020; 10:e033410. [PMID: 32317259 PMCID: PMC7204928 DOI: 10.1136/bmjopen-2019-033410] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Medical pluralism, or concurrent utilisation of multiple therapeutic modalities, is common in various international contexts, and has been characterised as a factor contributing to poor health outcomes in low-resource settings. Traditional healers are ubiquitous providers in most regions, including the study site of southwestern Uganda. Where both informal and formal healthcare services are both available, patients do not engage with both options equally. It is not well understood why patients choose to engage with one healthcare modality over the other. The goal of this study was to explain therapeutic itineraries and create a conceptual framework of pluralistic health behaviour. METHODS In-depth interviews were conducted from September 2017 to February 2018 with patients seeking care at traditional healers (n=30) and at an outpatient medicine clinic (n=30) in Mbarara, Uganda; the study is nested within a longitudinal project examining HIV testing engagement among traditional healer-using communities. Inclusion criteria included age ≥18 years, and ability to provide informed consent. Participants were recruited from practices representing the range of healer specialties. Following an inductive approach, interview transcripts were reviewed and coded to identify conceptual categories explaining healthcare utilisation. RESULTS We identified three broad categories relevant to healthcare utilisation: (1) traditional healers treat patients with 'care'; (2) biomedicine uses 'modern' technologies and (3) peer 'testimony' influences healthcare engagement. These categories describe variables at the healthcare provider, healthcare system and peer levels that interrelate to motivate individual engagement in pluralistic health resources. CONCLUSIONS Patients perceive clear advantages and disadvantages to biomedical and traditional care in medically pluralistic settings. We identified factors at the healthcare provider, healthcare system and peer levels which influence patients' therapeutic itineraries. Our findings provide a basis to improve health outcomes in medically pluralistic settings, and underscore the importance of recognising traditional healers as important stakeholders in community health.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Rachel King
- Global Health Sciences, UCSF Medical Center, San Francisco, California, USA
| | - Norma C Ware
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Mey A, Plummer D, Rogers GD, O’Sullivan M, Domberelli A, Anoopkumar-Dukie S. Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV. AIDS Behav 2019; 23:3396-3410. [PMID: 31388852 DOI: 10.1007/s10461-019-02623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.
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Ramirez-Garcia MP, Gagnon MP, Colson S, Côté J, Flores-Aranda J, Dupont M. Mind-body practices for people living with HIV: a systematic scoping review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:125. [PMID: 31185970 PMCID: PMC6560810 DOI: 10.1186/s12906-019-2502-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mind-body practices are frequently used by people living with HIV to reduce symptoms and improve wellbeing. These include Tai Chi, Qigong, yoga, meditation, and all types of relaxation. Although there is substantial research on the efficacy of mind-body practices in people living with HIV, there is no summary of the available evidence on these practices. The aim of this scoping review is to map available evidence of mind-body practices in people living with HIV. METHODS The Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) methodological framework was used. A search of 16 peer-review and grey literature databases, websites, and relevant journals (1983-2015) was conducted. To identify relevant studies, two reviewers independently applied the inclusion criteria to all abstracts or full articles. Inclusion criteria were: participants were people living with HIV; the intervention was any mind-body practice; and the study design was any research study evaluating one or several of these practices. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second, as needed, using the criteria that Cochrane Collaboration recommends for systematic reviews of interventions (Higgins and Green, Cochrane handbook for systematic reviews of intervention. 2011). A tabular and narrative synthesis was carried out for each mind-body practice. RESULTS One hundred thirty-six documents drawing on 84 studies met the inclusion criteria. The most widely studied mind-body practice was a combination of least three relaxation techniques (n = 20), followed in declining order by meditation (n = 17), progressive muscle relaxation (n = 10), yoga (n = 9) and hypnosis (n = 8). Slightly over half (47/84) of studies used a RCT design. The interventions were mainly (46/84) conducted in groups and most (51/84) included daily individual home practice. All but two studies were unblinded to participants. CONCLUSION The amount of available research on mind-body practices varies by practice. Almost half of the studies in this review were at high risk of bias. However, mindfulness, a combination of least three relaxation techniques and cognitive behavioral strategies, and yoga show encouraging results in decreasing physical and psychological symptoms and improving quality of life and health in people living with HIV. More rigorous studies are necessary to confirm the results of Tai Chi, Qigong, and some relaxation techniques.
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Affiliation(s)
- Maria Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Pier Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada
- Research Center of the Centre Hospitalier Universitaire, Québec, Canada
| | - Sébastien Colson
- Faculty of Medicine, Aix Marseille Université, Marseille, France
| | - José Côté
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Jorge Flores-Aranda
- University Institute on Addiction, Montreal-Island-South-Center Integrated University Health and Social Services Centre, Montréal, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
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Pan X, Zhang A, Henderson GE, Rennie S, Liu C, Cai W, Wu F, Tucker JD. Traditional, complementary, and alternative medical cures for HIV: rationale and implications for HIV cure research. Glob Public Health 2019; 14:152-160. [PMID: 29237332 PMCID: PMC6092229 DOI: 10.1080/17441692.2017.1413122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Traditional, complementary, and alternative medicine (TCAM) has been used by some people living with HIV (PLHIV) in an attempt to cure HIV. This article reviews the main factors influencing their decision to choose TCAM to cure HIV and discusses implications for HIV cure research. Those who decide to pursue traditional, complementary, and alternative medical cures may be influenced by the health system, cultural, and social dynamics, and their own individual beliefs and preferences. These same factors may impact participation in HIV cure research. People who search for traditional, complementary, and alternative medical cures may face special challenges as they are recruited, consented, and retained within HIV cure research studies. To address these potential challenges, we have suggested solutions focusing on culturally tailored communication and education, formative social science research, and community partnerships with key stakeholders. The social conditions that have promoted traditional, complementary and alternative medical cures will likely impact how PLHIV participate and experience HIV remission trials. Despite the potential challenges, it will be crucial to involve those who have previously sought out traditional cures for HIV in HIV cure research.
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Affiliation(s)
- Xin Pan
- University of North Carolina Project-China, Guangzhou, China
| | - Alice Zhang
- University of North Carolina Project-China, Guangzhou, China
- University of Maryland School of Medicine, Baltimore, USA
| | - Gail E. Henderson
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Eighth People’s Hospital, Guangzhou, China
| | - Feng Wu
- University of North Carolina Project-China, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
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9
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Oche OM, Sadiq UA, Oladigbolu RA, Chinna K. Prevalence and factors associated with the use of traditional medicines among human immunodeficiency virus and acquired immunodeficiency syndrome patients in Sokoto, Nigeria. Ann Afr Med 2018; 17:125-132. [PMID: 30185681 PMCID: PMC6126049 DOI: 10.4103/aam.aam_39_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In resource-scarce settings like Nigeria, access to conventional drugs and antiretroviral therapy (ART) is highly limited, hence the resort to use of traditional herbal medicine by a significant number of people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). Traditional medicine (TM) continues to provide health coverage for most of the people in developing countries, and it is equally becoming increasingly popular in western countries. Aim This study aims to present the status and use of TM and determine the factors associated with its use among patients with HIV/AIDS on highly active ART in a tertiary health institution in Sokoto, Northwest Nigeria. Methodology This was a descriptive, cross-sectional study involving HIV/AIDS patients attending antiretroviral treatment center of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The study population comprised PLWHAs attending the ART clinic of the hospital (UDUTH). A total of 271 respondents were recruited into the study and administered a set of pretested structured questionnaire. Ethical approval for this study was obtained from the ethical committee of the teaching hospital. Results Only 11 (4.2%) of the respondents had used TM before, of whom 9 (5%) were females and 2 (2.7%) were males with P = 0.399. Only one of the respondents had side effects following the use of TM, and the most common reason for the use of TM was as a result of too much weight loss. Conclusion Although the use of TM among the study participants in Sokoto was low, there is need to educate PLWHAs about the possible risks of interactions following the concurrent use of TM and ART.
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Affiliation(s)
- Oche Mansur Oche
- Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Umar Abubakar Sadiq
- Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Remi Abiola Oladigbolu
- Department of Community Health, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
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10
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Pattern of Traditional Medicine Utilization among HIV/AIDS Patients on Antiretroviral Therapy at a University Hospital in Northwestern Ethiopia: A Cross-Sectional Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:1724581. [PMID: 28421118 PMCID: PMC5380827 DOI: 10.1155/2017/1724581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/15/2017] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
The objective of this study was to assess traditional, complementary, and alternative medicine (TCAM) utilization pattern among HIV/AIDS patients on antiretroviral therapy at University of Gondar Comprehensive Specialized Hospital. Materials and Methods. Data on sociodemographic profile and clinical and TCAM utilization were collected using a structured, pretested questionnaire from April 01 to May 28, 2014, through interviews with patients. Data on CD4 count, HIV stage, and ART regimen were collected from patient records. Analysis was conducted descriptively using SPSS version 20. Results. Of the 300 participants, 43.7% reported using TCAM, with the largest proportion of them from religious institutions (churches/mosques) (41.22%), followed by home prepared (32.82%) and traditional healers (16.03%). The leading forms of TCAM used were spiritual and herbal therapies constituting 56.49% and 36.64% of the patients, respectively. The most frequently used herbal products included Nigella sativa (22.92%) and Moringa oleifera (20.83%). Most of the patients (73.30%) using TCAM reported improvement in their conditions. Conclusions. TCAM utilization among HIV/AIDS patients on ART was common and different sources and types were used alongside ART, with improvement reported by most. Further research is needed to identify CAM therapies which may be used as adjunct treatments among these patients.
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Wanyama JN, Tsui S, Kwok C, Wanyenze RK, Denison JA, Koole O, van Praag E, Castelnuovo B, Wabwire-Mangen F, Kwesigabo GP, Colebunders R. Persons living with HIV infection on antiretroviral therapy also consulting traditional healers: a study in three African countries. Int J STD AIDS 2017; 28:1018-1027. [PMID: 28162034 DOI: 10.1177/0956462416685890] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditional healers provide healthcare to a substantial proportion of people living with HIV infection (PLHIV) in high HIV burden countries in sub-Saharan Africa. However, the impact on the health of retained patients visiting traditional healers is unknown. In 2011, a study to asses adherence to anti-retroviral therapy (ART) performed in 18 purposefully selected HIV treatment centers in Tanzania, Zambia and Uganda showed that 'consulting a traditional healer/herbalist because of HIV' was an independent risk factor for incomplete ART adherence. To identify characteristics of PLHIV on ART who were also consulting traditional healers, we conducted a secondary analysis of the data from this study. It was found that 260 (5.8%) of the 4451 patients enrolled in the study had consulted a traditional healer during the last three months because of HIV. In multivariable analysis, patients with fewer HIV symptoms, those who had been on ART for >5.3 years and those from Tanzania were more likely to have consulted a traditional healer. However, at the time of the study, there was a famous healer in Manyara district, Loliondo village of Tanzania who claimed his herbal remedy was able to cure all chronic diseases including HIV. HIV treatment programs should be aware that patients with fewer HIV symptoms, those who have been on ART for five or more years, and patients attending ART centers near famous traditional healers are likely to consult traditional healers. Such patients may need more support or counseling about the risks of both stopping ART and poor adherence. Considering the realities of inadequate human resources for health and the burden of disease caused by HIV in sub-Saharan Africa, facilitating a collaboration between allopathic and traditional health practitioners is recommended.
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Affiliation(s)
- Jane N Wanyama
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sharon Tsui
- 2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA
| | - Cynthia Kwok
- 2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA
| | - Rhoda K Wanyenze
- 3 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julie A Denison
- 4 Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - Olivier Koole
- 5 Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | | | - Barbara Castelnuovo
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Wabwire-Mangen
- 3 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gideon P Kwesigabo
- 7 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Robert Colebunders
- 5 Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium.,8 Global Health Institute, University of Antwerp, Belgium
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Abou-Rizk J, Alameddine M, Naja F. Prevalence and Characteristics of CAM Use among People Living with HIV and AIDS in Lebanon: Implications for Patient Care. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:5013132. [PMID: 28050191 PMCID: PMC5168459 DOI: 10.1155/2016/5013132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/07/2016] [Indexed: 01/25/2023]
Abstract
This study aimed to assess the prevalence and determinants of Complementary and Alternative Medicine (CAM) use among People Living with HIV and AIDS (PLWHA) in Lebanon and to identify related issues that may affect patient care. A cross-sectional survey design was used to interview 116 PLWHA in Beirut. The questionnaire addressed sociodemographic and disease characteristics as well as CAM use. The main outcome of the study was CAM use since diagnosis. Data analysis included descriptive statistics and logistic regression analyses. Overall, 46.6% of participants reported using one or more CAM therapies, with herbs and herbal products being the most commonly used (63%). A higher education level was associated with a 3-fold increase in the odds of CAM use. Among users, 20% used CAM as alternative to conventional treatment, 48% were not aware of CAM-drug interactions, 89% relied on nonhealth care sources for their choice of CAM, and 44% did not disclose CAM use to their physician. CAM use is prevalent among Lebanese PLWHA. Findings of this study highlighted the need to educate health care practitioners to have an open communication and a patient-centered approach discussing CAM use during routine care and to enhance awareness of PLWHA on safe use of CAM.
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Affiliation(s)
- Joana Abou-Rizk
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mohamad Alameddine
- Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, P.O. Box 505055, Dubai, UAE
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Farah Naja
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
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Brooks KM, George JM, Kumar P. Drug interactions in HIV treatment: complementary & alternative medicines and over-the-counter products. Expert Rev Clin Pharmacol 2016; 10:59-79. [PMID: 27715369 DOI: 10.1080/17512433.2017.1246180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Use of complementary and alternative medicines (CAMs) and over-the-counter (OTC) medications are very common among HIV-infected patients. These products can cause clinically significant drug-drug interactions (DDIs) with antiretroviral (ARV) medications, thereby increasing risk for negative outcomes such as toxicity or loss of virologic control. Areas covered: This article provides an updated review of the different mechanisms by which CAM and OTC products are implicated in DDIs with ARV medications. Expert commentary: Much of the literature published to date involves studies of CAMs interacting with older ARV agents via the cytochrome P450 (CYP450) system. However, the HIV treatment and prevention arsenal is continually evolving. Furthermore, our elucidation of the role of non-CYP450 mediated DDIs with ARV medications is greatly increasing. Therefore, clinicians are well served to understand the various mechanisms and extent by which new ARV therapies may be involved in drug interactions with CAMs and OTC medications.
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Affiliation(s)
- Kristina M Brooks
- a Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy Department , National Institutes of Health , Bethesda , MD , USA
| | - Jomy M George
- a Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy Department , National Institutes of Health , Bethesda , MD , USA
| | - Parag Kumar
- a Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy Department , National Institutes of Health , Bethesda , MD , USA
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Muramoto ML, Gordon JS, Bell ML, Nichter M, Floden L, Howerter A, Ritenbaugh CK. Tobacco Cessation Training for Complementary and Alternative Medicine Practitioners: Results of a Practice-Based Trial. Am J Prev Med 2016; 51:e35-e44. [PMID: 27061892 DOI: 10.1016/j.amepre.2016.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/19/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Brief behavioral intervention (BI) is a tobacco-cessation best practice well established among conventional healthcare practitioners. Complementary and alternative medicine (CAM) practitioners treat significant numbers of tobacco users, but do not systematically receive BI training. The CAM Reach study developed and evaluated a tobacco cessation BI training program/practice system intervention adapted specifically for CAM practitioners, and evaluated in real-world CAM practices. STUDY DESIGN Single-arm intervention. Data were collected in 2010-2014 and analyzed in 2015. SETTING/PARTICIPANTS Private practices of 30 chiropractors, 27 acupuncturists, 42 massage therapists (N=99), in metropolitan Tucson, Arizona. INTERVENTION Eight-hour tobacco cessation BI continuing education workshop, in-office BI skills practice/assessment, and system intervention. Training tailored to the CAM practice setting addressed tobacco cessation best practices from the U.S. Public Health Service Guidelines. MAIN OUTCOME MEASURES Seventeen items (assessing practitioner behavior, motivation, and self-efficacy with tobacco cessation) comprising three factors, Tobacco Cessation Activity, Tobacco Cessation Motivation, and Non-CAM Tobacco Cessation Comfort, were assessed at baseline and 3, 6, 9, and 12 months post-training by practitioner self-report. Research staff visited practices at approximately the same intervals to directly observe changes in clinical practice systems. RESULTS At 3 months, there were significant increases in practitioners' tobacco cessation activities, motivation and confidence in helping patients quit tobacco, and comfort with providing information and referrals for guideline-based tobacco cessation aids (p<0.0001). Practitioners significantly increased rates of discussing cessation medications with patients (AOR=3.76, 95% CI=1.84, 7.68), and routinely asking about tobacco use in clinical practice (AOR=2.62, 95% CI=1.11, 6.20). Increases occurred across all three practitioner types and were sustained at 12 months-despite heterogeneity in professional training, practice patterns/organization, and practice business models. CONCLUSIONS Results suggest CAM practitioners are willing and able to offer BIs, and are an important, yet overlooked channel for promoting tobacco cessation and use of evidence-based cessation aids.
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Affiliation(s)
- Myra L Muramoto
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona.
| | - Judith S Gordon
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Mark Nichter
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona; School of Anthropology, College of Social and Behavioral Sciences, University of Arizona, Tucson, Arizona
| | - Lysbeth Floden
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Amy Howerter
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
| | - Cheryl K Ritenbaugh
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona
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Syed IA, Sulaiman SAS, Hassali MA, Thiruchelvam K, Syed SH, Lee CK. Beliefs and practices of complementary and alternative medicine (CAM) among HIV/AIDS patients: A qualitative exploration. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.09.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mukolo A, Cooil B, Victor B. The effects of utility evaluations, biomedical knowledge and modernization on intention to exclusively use biomedical health facilities among rural households in Mozambique. Soc Sci Med 2015; 138:225-33. [PMID: 26123881 DOI: 10.1016/j.socscimed.2015.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In resource-limited settings, the choice between utilizing biomedical health services and/or traditional healers is critical to the success of the public health mission. In the literature, this choice has been predicted to be influenced by three major factors: knowledge about biomedical etiologies; cultural modernization; and rational choice. The current study investigated all three of these predicted determinants, applying data from a general household survey conducted in 2010 in Zambézia Province of Mozambique involving 1045 randomly sampled rural households. Overall, more respondents (N = 802) intended to continue to supplement their biomedical healthcare with traditional healer services in comparison with those intending to utilize biomedical care exclusively (N = 243). The findings strongly supported the predicted association between rational utility (measured as satisfaction with the quality of service and results from past care) with the future intention to continue to supplement or utilize biomedical care exclusively. Odds of moving away from supplementation increase by a factor of 2.5 if the respondent reported seeing their condition improve under government/private biomedical care. Odds of staying with supplementation increase by a factor 3.1 if the respondent was satisfied with traditional care and a factor of 16 if the condition had improved under traditional care. Modernization variables (education, income, religion, and Portuguese language skills) were relevant and provided a significant component of the best scientific model. Amount of biomedical knowledge was not a significant predictor of choice. There was a small effect on choice from knowing the limitations of biomedical care. The findings have implications for public healthcare promotion activities in areas where biomedical care is introduced as an alternative to traditional healing.
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Affiliation(s)
- Abraham Mukolo
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, 2525 West End Avenue, Nashville, TN 37203, USA; Mental Health America of Middle Tennessee, 295 Plus Park Boulevard, Nashville, TN 37217, USA.
| | - Bruce Cooil
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN 37201, USA
| | - Bart Victor
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN 37201, USA
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Muramoto ML, Matthews E, Ritenbaugh CK, Nichter MA. Intervention development for integration of conventional tobacco cessation interventions into routine CAM practice. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:96. [PMID: 25887742 PMCID: PMC4391469 DOI: 10.1186/s12906-015-0604-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022]
Abstract
Background Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners – that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. Methods Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. Results CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. Conclusions The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner’s role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners’ work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners’ clinical behavior is underway.
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18
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Cheng BH, Zhou X, Wang Y, Chan JYW, Lin HQ, Or PMY, Wan DCC, Leung PC, Fung KP, Wang YF, Lau CBS. Herb-drug interaction between an anti-HIV Chinese herbal SH formula and atazanavir in vitro and in vivo. JOURNAL OF ETHNOPHARMACOLOGY 2015; 162:369-376. [PMID: 25614104 DOI: 10.1016/j.jep.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE With the prevalent use of highly active antiretroviral therapy (HAART) for AIDS patients since 1996, the mortality of HIV/AIDS patients has been remarkably decreased. With long-term use of HAART, drug resistance and side effects of antiretrovirals have been frequently reported, which not only reduce the efficacy, but also decreases the tolerance of patients. Traditional herbal medicine has become more popular among HIV/AIDS patients as adjuvant therapy to reduce these adverse effects of HAART. SH formula is a Chinese herbal formula consisting of five traditional Chinese herbs including Morus alba L., Glycyrrhiza glabra L., Artemisia capillaris Thumb., Astragalus membranaceus Bge., and Carthamus tinctorius L. SH formula is clinically used for HIV treatment in Thailand. However, the possible pharmacokinetic interactions between these Chinese herbs and antiretroviral drugs have not been well documented. The aim of this study was to investigate the potential herb-drug interaction between SH herbal Chinese formula and the antiretroviral drug atazanavir (ATV). MATERIALS AND METHODS The combination effect of SH formula and ATV on HIV protease was studied in HIV-1 protease inhibition assay in vitro. The inhibition of SH formula on rat CYP3A2 was assessed by detecting the formation of 1'-OH midazolam from midazolam in rat liver microsomes in vitro. The in vivo pharmacokinetic interaction between SH formula and ATV was investigated by measuring time-dependent plasma concentrations of ATV in male Sprague-Dawley rats with liquid chromatography-mass spectrometry. RESULTS Through the in vitro HIV-1 protease inhibition assay, combination of SH formula (41.7-166.7 μg/ml) and ATV (16.7-33.3 ng/ml) showed additive inhibition on HIV-1 protease activity than SH formula or ATV used alone. In vitro incubation assay indicated that SH formula showed a weak inhibition (IC50=231.2 µg/ml; Ki=98.2 µg/ml) on CYP3A2 activity in rat liver microsomes. In vivo pharmacokinetic study demonstrated that SH formula did not affect the metabolism of ATV in rats. CONCLUSIONS Our study demonstrated for the first time that there is no metabolism-based herb-drug interaction between SH formula and ATV in rats, but this combination enhances the inhibition potentials against HIV protease activity. This observation may support the combinational use of anti-HIV treatment in human.
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Affiliation(s)
- Bao-Hui Cheng
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Xuelin Zhou
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Yan Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences, Beijing 100050, China
| | - Judy Yuet-Wa Chan
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Huang-Quan Lin
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Penelope M Y Or
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - David Chi-Cheong Wan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Ping-Chung Leung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Kwok-Pui Fung
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Yi-Fen Wang
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, China
| | - Clara Bik-San Lau
- Institute of Chinese Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China; State Key Laboratory of Phytochemistry and Plant Resources in West China, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.
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Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia. AIDS 2015; 29:361-71. [PMID: 25686684 DOI: 10.1097/qad.0000000000000543] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To characterize antiretroviral therapy (ART) adherence across different programmes and examine the relationship between individual and programme characteristics and incomplete adherence among ART clients in sub-Saharan Africa. DESIGN A cross-sectional study. METHODS Systematically selected ART clients (≥18 years; on ART ≥6 months) attending 18 facilities in three countries (250 clients/facility) were interviewed. Client self-reports (3-day, 30-day, Case Index ≥48 consecutive hours of missed ART), healthcare provider estimates and the pharmacy medication possession ratio (MPR) were used to estimate ART adherence. Participants from two facilities per country underwent HIV RNA testing. Optimal adherence measures were selected on the basis of degree of association with concurrent HIV RNA dichotomized at less than or greater/equal to 1000 copies/ml. Multivariate regression analysis, adjusted for site-level clustering, assessed associations between incomplete adherence and individual and programme factors. RESULTS A total of 4489 participants were included, of whom 1498 underwent HIV RNA testing. Nonadherence ranged from 3.2% missing at least 48 consecutive hours to 40.1% having an MPR of less than 90%. The percentage with HIV RNA at least 1000 copies/ml ranged from 7.2 to 17.2% across study sites (mean = 9.9%). Having at least 48 consecutive hours of missed ART was the adherence measure most strongly related to virologic failure. Factors significantly related to incomplete adherence included visiting a traditional healer, screening positive for alcohol abuse, experiencing more HIV symptoms, having an ART regimen without nevirapine and greater levels of internalized stigma. CONCLUSION Results support more in-depth investigations of the role of traditional healers, and the development of interventions to address alcohol abuse and internalized stigma among treatment-experienced adult ART patients.
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Appelbaum Belisle H, Hennink M, Ordóñez CE, John S, Ngubane-Joye E, Hampton J, Sunpath H, Preston-Whyte E, Marconi VC. Concurrent use of traditional medicine and ART: Perspectives of patients, providers and traditional healers in Durban, South Africa. Glob Public Health 2014; 10:71-87. [PMID: 25346069 DOI: 10.1080/17441692.2014.967709] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The concurrent use of traditional African medicine (TAM) and allopathic medicine is not well understood for people living with HIV (PLHIV) in the era of antiretroviral therapy (ART). This cross-sectional, qualitative study examines perceptions of the concurrent use of TAM and ART among: (1) patients receiving ART at the Sinikithemba HIV Clinic of McCord Hospital, in Durban, South Africa; (2) allopathic medical providers (doctors, nurses and HIV counsellors) from Sinikithemba; and (3) local traditional healers. Data were collected through in-depth interviews and focus group discussions with 26 participants between July and October, 2011. Patients in this study did not view TAM as an alternative to ART; rather, results show that patients employ TAM and ART for distinctly different needs. More research is needed to further understand the relationship between traditional and allopathic approaches to health care in South Africa, to improve cultural relevance in the provision and delivery of care for PLHIV, and to pragmatically address the concerns of health care providers and public health officials managing this intersection in South Africa and elsewhere.
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Affiliation(s)
- Hannah Appelbaum Belisle
- a Hubert Department of Global Health, Rollins School of Public Health , Emory University , Atlanta , GA , USA
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O'Brien S, Broom A. HIV in (and out of) the clinic: biomedicine, traditional medicine and spiritual healing in Harare. SAHARA J 2014; 11:94-104. [PMID: 25017937 PMCID: PMC4272101 DOI: 10.1080/17290376.2014.938102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Contemporary lived experiences of the human immunodeficiency virus (HIV) are shaped by clinical and cultural encounters with illness. In sub-Saharan countries such as Zimbabwe, HIV is treated in very different ways in various therapeutic contexts including by biomedical experts, traditional medicine and faith healers. The co-existence of such expertise raises important questions around the potencies and limits of medicalisation and alternative healing practices in promoting HIV recovery. First, in this study, drawing on in-depth qualitative interviews with 60 people from poor urban areas in Harare, we explore the experiences of people living with and affected by HIV. Specifically, we sought to document, interrogate and reflect on their perceptions and experiences of biomedicine in relation to traditional medicine and spiritual healing. Their accounts indicate that traditional medicine and spiritual beliefs continue to significantly influence the way in which HIV is understood, and the forms of help and care people seek. Second, we observe the dramatic and overwhelmingly beneficial impact of Antiretroviral Therapy and conclude through Zimbabwean's own stories that limitations around delivery and wider structural inequalities impede its potential. Lastly, we explore some practical implications of the biomedical clinic (and alternative healing practices) being understood as sites of ideological and expert contestation. This paper aimed to add to our knowledge of the relationships between traditional medicine and spiritual healing in connection with biomedicine and how this may influence HIV treatment and prevention.
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Affiliation(s)
- Stephen O'Brien
- a PhD Sociology, is a tutor at the School of Humanities and Social Science , The University of Newcastle , Newcastle , Australia , *
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Lorenc A, Robinson N. A review of the use of complementary and alternative medicine and HIV: issues for patient care. AIDS Patient Care STDS 2013; 27:503-10. [PMID: 23991688 DOI: 10.1089/apc.2013.0175] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV/AIDS is a chronic illness, with a range of physical symptoms and psychosocial issues. The complex health and social issues associated with living with HIV mean that people living with HIV/AIDS (PLWHA) have historically often turned to complementary and alternative medicine (CAM). This article provides an overview of the literature on HIV and CAM. Databases were searched using keywords for CAM and HIV from inception to December 2012. Articles in English and in Western countries were included; letters, commentaries, news articles, articles on specific therapies and basic science studies were excluded. Of the 282 articles identified, 94 were included. Over half reported prevalence and determinants of CAM use. Lifetime use of CAM by PLWHA ranged from 30% to 90%, with national studies suggesting CAM is used by around 55% of PLWHA, practitioner-based CAM by 15%. Vitamins, herbs, and supplements were most common, followed by prayer, meditation, and spiritual approaches. CAM use was predicted by length of time since HIV diagnosis, and a greater number of medications/symptoms, with CAM often used to address limitations or problems with antiretroviral therapy. CAM users rarely rejected conventional medicine, but a number of CAM can have potentially serious side effects or interactions with ART. CAM was used as a self-management approach, providing PLWHA with an active role in their healthcare and sense of control. Clinicians, particularly nurses, should consider discussing CAM with patients as part of patient-centered care, to encourage valuable self-management and ensure patient safety.
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Affiliation(s)
- Ava Lorenc
- London South Bank University, London, United Kingdom
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Muñoz FA, Servin AE, Kozo J, Lam M, Zúñiga ML. A binational comparison of HIV provider attitudes towards the use of complementary and alternative medicine among HIV-positive Latino patients receiving care in the US-Mexico border region. AIDS Care 2012; 25:990-7. [PMID: 23088506 DOI: 10.1080/09540121.2012.729806] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Use of complementary and alternative medicine (CAM) is common among Latinos living with HIV in the United States (US)-Mexico border region. Health providers may vary in their approach to communicating acceptance or non acceptance of CAM use, which can undermine patient confidence in disclosing CAM use. Patient-provider communication about CAM is important because certain types of CAM can affect antiretroviral therapy (ART) adherence. We undertook the present binational study to understand US and Mexican provider beliefs, and perceptions surrounding CAM use among Latino patients, and to learn if and how CAM communication occurs. Between July and December 2010, we conducted in-depth, qualitative interviews in Tijuana and San Diego. Analysis procedures drew upon principles of Grounded Theory. The sample was comprised of 19 HIV-health care providers, including 7 women and 12 men. Emerging CAM-related themes were: Provider's perceptions, attitudes and knowledge about CAM; CAM types and modalities; and patient-provider CAM communication. Many clinicians were uncomfortable supporting CAM use with their patients. San Diego providers reported more frequent instances of CAM use among Latino patients than Tijuana providers. Providers from both cities reported that patients infrequently disclose CAM use and almost half do not routinely ask patients about CAM practices. Most of the providers acknowledged that they lack information about CAM, and are concerned about the drug interaction as well as the effects of CAM on adherence. Our findings have important implications for understanding provider communication surrounding CAM use in a highly transnational population and context. Because CAM use may undermine ART adherence and is highly prevalent among Latinos, provider communication about CAM is critical to improved health outcomes among HIV-positive Latinos. Considering the significant growth of US Latinos, especially in the US-Mexico border region, assessment of Mexican and US provider training and communication needs surrounding Latino patient CAM use is warranted.
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Affiliation(s)
- Fátima A Muñoz
- Division of Global Public Health, Department of Medicine, University of California, San Diego, la Jolla, CA, USA
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Servin AE, Muñoz FA, Strathdee SA, Kozo J, Zúñiga ML. Choosing sides: HIV health care practices among shared populations of HIV-positive Latinos living near the US-Mexico border. ACTA ACUST UNITED AC 2012; 11:348-55. [PMID: 22930794 DOI: 10.1177/1545109712453854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We compared HIV-positive patients receiving care in the border cities of San Diego, United States, with Tijuana, Mexico. METHODS Participants were HIV-positive Latinos (n = 233) receiving antiretroviral therapy (ART) from San Diego-Tijuana clinics (2009-2010). Logistic regression identified correlates of receiving HIV care in San Diego versus Tijuana. RESULTS Those with their most recent HIV visit in San Diego (59%) were more likely to be older, have at least a high school education, and were less likely to have been deported than those with last visits in Tijuana. Despite reporting better patient-provider relationships and less HIV-related stigma than those with visits in Tijuana, San Diego patients were twice as likely to make unsupervised changes in their ART regimen. CONCLUSIONS We observed poorer relative adherence among HIV-positive Latinos receiving care in San Diego, despite reports of good clinical relationships. Further study is needed to ascertain underlying reasons to avoid ART-related resistance.
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Affiliation(s)
- Argentina E Servin
- 1Department of Medicine, Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA
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