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Perrone C, Kanthawang N, Cheah PY, Intralawan D, Lee SJ, Nedsuwan S, Fuwongsitt B, Wangrangsimakul T, Greer RC. Community engagement around scrub typhus in northern Thailand: a pilot project. Trans R Soc Trop Med Hyg 2024:trae028. [PMID: 38708716 DOI: 10.1093/trstmh/trae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/08/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Scrub typhus is highly endemic in northern Thailand yet awareness and knowledge are low. We developed a community engagement project to improve awareness in communities at risk of contracting scrub typhus. METHODS We conducted a series of engagement sessions with healthcare workers and community health volunteers so they would, in turn, engage with their communities. We evaluated our activities by assessing the increase in scrub typhus knowledge, using a series of Likert-scale items and open-ended questions. Three to 6 months after the sessions, participants were followed up to collect their experiences training community members. RESULTS Of 134 participants who took part in eight sessions, 87.3% were community health volunteers. Disease knowledge increased substantially after the sessions and was well maintained for up to 5 mo. Satisfaction was high and, through participant feedback, engagement materials were improved to be more useful to the communities. People with higher education had higher scores and retention. CONCLUSIONS Community engagement was shown to be an effective tool to develop and carry out health-promoting activities in a culturally and context-appropriate manner.
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Affiliation(s)
- Carlo Perrone
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Nipaphan Kanthawang
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Daranee Intralawan
- Social and Preventive Medicine Department, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand
| | - Sue J Lee
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Supalert Nedsuwan
- Social and Preventive Medicine Department, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand
| | - Benjarat Fuwongsitt
- Social and Preventive Medicine Department, Chiang Rai Prachanukroh Hospital, Chiang Rai 57000, Thailand
| | - Tri Wangrangsimakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Rachel C Greer
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
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Apangu T, Candini G, Abaru J, Candia B, Okoth FJ, Atiku LA, Griffith KS, Hayden MH, Zielinski-Gutiérrez E, Schwartz AM, McCormick DW, Mead PS, Kugeler KJ. Engagement with Traditional Healers for Early Detection of Plague in Uganda. Am J Trop Med Hyg 2023; 109:1129-1136. [PMID: 37783460 PMCID: PMC10622458 DOI: 10.4269/ajtmh.23-0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/15/2023] [Indexed: 10/04/2023] Open
Abstract
In rural Uganda, many people who are ill consult traditional healers prior to visiting the formal healthcare system. Traditional healers provide supportive care for common illnesses, but their care may delay diagnosis and management of illnesses that can increase morbidity and mortality, hinder early detection of epidemic-prone diseases, and increase occupational risk to traditional healers. We conducted open-ended, semi-structured interviews with a convenience sample of 11 traditional healers in the plague-endemic West Nile region of northwestern Uganda to assess their knowledge, practices, and attitudes regarding plague and the local healthcare system. Most were generally knowledgeable about plague transmission and its clinical presentation and expressed willingness to refer patients to the formal healthcare system. We initiated a public health outreach program to further improve engagement between traditional healers and local health centers to foster trust in the formal healthcare system and improve early identification and referral of patients with plaguelike symptoms, which can reflect numerous other infectious and noninfectious conditions. During 2010-2019, 65 traditional healers were involved in the outreach program; 52 traditional healers referred 788 patients to area health centers. The diagnosis was available for 775 patients; malaria (37%) and respiratory tract infections (23%) were the most common diagnoses. One patient had confirmed bubonic plague. Outreach to improve communication and trust between traditional healers and local healthcare settings may result in improved early case detection and intervention not only for plague but also for other serious conditions.
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Affiliation(s)
| | | | - Janet Abaru
- Uganda Virus Research Institute, Arua, Uganda
| | | | | | | | | | - Mary H. Hayden
- National Center for Atmospheric Research, Boulder, Colorado
| | | | - Amy M. Schwartz
- Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | - Paul S. Mead
- Centers for Disease Control and Prevention, Fort Collins, Colorado
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Sundararajan R, Ponticiello M, Birch G, Nuwagaba G, Alaiku R, Nansera D, Mwanga-Amumpaire J, Muyindike W. Adaption and pilot testing of a lay HIV supporter program for traditional healers: a mixed methods study in rural Uganda. Implement Sci Commun 2023; 4:87. [PMID: 37501077 PMCID: PMC10373386 DOI: 10.1186/s43058-023-00469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Half of people living with HIV (PLWH) in sub-Saharan Africa default from care within two years. In Uganda, and across sub-Saharan Africa, traditional healers (TH) are ubiquitous and often serve as the first line of health care. We hypothesized that with lay support training, TH could support relinkage to HIV care and ART adherence among rural Ugandan PLWH who have defaulted from HIV care. METHODS Following the ADAPT-ITT framework, we adapted an evidence-based layperson HIV support program from South Africa for delivery by Ugandan TH. The ADAPT-ITT framework consists of (1) Assessment of needs; (2) Deciding which evidence-based interventions to adapt; (3) Adaptation of interventions; (4) Production of drafted adapted interventions; (5) Topical expert feedback; (6) Integration of expert feedback; (7) Training personnel; and (8) Testing the adapted intervention. The Testing phase was completed via a pilot mixed methods prospective cohort study. The study population included 12 TH practicing in Mbarara Township and 20 adult PLWH with suboptimal ART adherence (CASE adherence index score < 10) who received care from a participating TH and who resided in Mbarara Township. Primary outcome was re-linkage to HIV care within 14 days. Secondary outcomes were ART re-initiation, ART adherence, retention in care after 9 months, and implementation measures. Qualitative interviews were conducted with all participants. RESULTS Data from the Assessment phase indicated that logistical challenges played an important role in disengagement from care among PLWH who receive care from TH, notably geographical distance to clinics and transportation costs. Additionally, HIV-related stigma and lack of social support were identified as barriers to entering and remaining in HIV care. Two core elements of the intervention were identified during the Production phase: (1) TH facilitating rapid re-linkage to HIV care and (2) TH provision of psychosocial support. In the pilot study phase, baseline median CASE adherence score was 3; only 5% of PLWH were adherent to ART via 4-day recall. The TH-delivered support achieved 100% linkage and ART initiation within 14 days, 95% ART adherence, and 100% of PLWH were retained in HIV care after 9 months. CONCLUSIONS The ADAPT-ITT framework successfully guided the adaption of a community health worker-delivered intervention for delivery by TH. TH successfully facilitated re-linkage to HIV care, support ART adherence, and retention in care for PLWH when trained as part of a lay support person program. Future studies are needed to evaluate scale-up and long-term impact.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | | | | | | | - Rinu Alaiku
- Weill Cornell Medical College, Weill Cornell Medicine, New York, USA
| | - Denis Nansera
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
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4
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Audet CM, Pettapiece-Phillips M, Tian Y, Shepherd BE, Vermund SH, Salato J. "If it weren't for my traditional healer, I would be dead": Engaging traditional healers to support people living with HIV in rural Mozambique. PLoS One 2022; 17:e0270565. [PMID: 35763519 PMCID: PMC9239464 DOI: 10.1371/journal.pone.0270565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Across rural sub-Saharan Africa, people living with HIV (PLHIV) commonly seek out treatment from traditional healers. We report on the clinical outcomes of a community health worker intervention adapted for traditional healers with insight into our results from qualitative interviews. We employed a pre-post intervention study design and used sequential mixed methods to assess the impact of a traditional healer support worker intervention in Zambézia province, Mozambique. After receiving a positive test result, 276 participants who were newly enrolled in HIV treatment and were interested in receiving home-based support from a traditional healer were recruited into the study. Those who enrolled from February 2016 to August 2016 received standard of care services, while those who enrolled from June 2017 to May 2018 received support from a traditional healer. We conducted interviews among healers and participants to gain insight into fidelity of study activities, barriers to support, and program improvement. Medication possession ratio at home (based on pharmacy pick-up dates) was not significantly different between pre- and post-intervention participants (0.80 in the pre-intervention group compared to 0.79 in the post-intervention group; p = 0.96). Participants reported receiving educational and psychosocial support from healers. Healers adapted their support protocol to initiate directly observed therapy among participants with poor adherence. Traditional healers can provide community-based psychosocial support, education, directly observed therapy, and disclosure assistance for PLHIV. Multiple factors may hinder patients' desire and ability to remain adherent to treatment, including poverty, confusion about medication side effects, and frustration with wait times at the health facility.
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Affiliation(s)
- Carolyn M. Audet
- Department of Health Policy, Vanderbilt University, Nashville, TN, United States of America
| | | | - Yuqi Tian
- Department of Biostatistics, Vanderbilt University, Nashville, TN, United States of America
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University, Nashville, TN, United States of America
| | - Sten H. Vermund
- School of Public Health, Yale University, New Haven, CT, United States of America
| | - Jose Salato
- Friends in Global Health, Quelimane, Mozambique
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Sundararajan R, Langa PV, Morshed T, Manuel S. Traditional healers as client advocates in the HIV-endemic region of Maputo, Mozambique: results from a qualitative study. SAHARA J 2021; 18:77-85. [PMID: 33902401 PMCID: PMC8081305 DOI: 10.1080/17290376.2021.1909492] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Traditional healers are commonly utilised throughout sub-Saharan Africa instead of - and in concert with - biomedical facilities. Traditional healers are trusted providers and prominent community members and could be important partners in improving engagement with HIV services in endemic contexts. Our study sought to understand the roles of healers in the urban setting of Maputo, Mozambique, where HIV prevalence is high and testing rates are low. Qualitative data were gathered through minimally structured interviews with 36 healers. Analysis followed an inductive, grounded theory approach. Data reveal three themes relevant to improving engagement with HIV services in this endemic region: (1) healers have positive attitudes towards biomedicine; (2) healers advocate for their sick clients and (3) clients are reticent to present to biomedical facilities. Healers describe their roles as 'cooperative' with biomedical providers to provide healthcare for their clients. Results suggest that healers could be considered critical enablers to effective HIV programmes in communities. They have social and symbolic capital that positions them to beneficially influence clients and are natural partners for interventions to improve uptake of HIV services.
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Affiliation(s)
| | - Patricio V. Langa
- Faculty of Arts and Social Sciences, Universidade Eduardo Mondlane, Maputo City, Mozambique
| | - Trisha Morshed
- Emergency Medicine, Banner Medical Center, Vituity Physician Group, Sun City, AZ, USA
| | - Sandra Manuel
- Faculty of Education, Universidade Eduardo Mondlane, Maputo City, Mozambique
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Amosse F, Boene H, Kinshella MLW, Drebit S, Sharma S, Makanga PT, Valá A, Magee LA, von Dadelszen P, Vidler M, Sevene E, Munguambe K. Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:S122-S136. [PMID: 33727325 PMCID: PMC7971369 DOI: 10.9745/ghsp-d-20-00511] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
Encouraging local transport programs and transport infrastructure in poorly-resourced communities can help improve community access and strengthen engagement with health systems. Mobilizing community resources and leadership to implement a community-based transport scheme in rural Mozambique to support referrals to health facilities can help improve maternal and child health outcomes. Introduction: Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program to improve access to emergency obstetric care in southern Mozambique. Methods: From April 2016 to February 2017, a community transport strategy was implemented as part of the Community Level Interventions for Pre-eclampsia Trial. The study aimed to reduce maternal and perinatal mortality and morbidity by 20% in intervention clusters in Maputo and Gaza Provinces, Mozambique, by involving community health workers in the identification and referral of pregnant and puerperal women at risk. Based on a community-based participatory needs assessment, the transport program was implemented with the trial. Demographics, conditions requiring transportation, means of transport used, route, and outcomes were collected during implementation. Data were entered into a REDCap database. Results: Fifty-seven neighborhoods contributed to the needs assessment; of those, 13 (23%) implemented the transport program. Neighborhoods were selected based on their expression of interest and ability to contribute financially to the program (US$0.33 per family per month). In each selected neighborhood, a community management committee was created, training in small-scale financial management was conducted, and monitoring tools were provided. Twenty people from 9 neighborhoods benefited from the transport program, 70% were pregnant and postpartum women. Conclusion: These results demonstrate that it was feasible to implement a community-based transport program with no external input of vehicles, fuel, personnel, and maintenance. However, high cost and a lack of acceptable transport options in some communities continue to impede access to obstetric health care services and the ability for timely follow-up. When strengthening capacities of community health workers to promptly assist and refer emergency cases, it is crucial to encourage local transport programs and transportation infrastructure among minimally resourced communities to support access and engagement with health systems.
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Affiliation(s)
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sharla Drebit
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Prestige Tatenda Makanga
- Place Alert Labs, Surveying, and Geomatics Department, Midlands State University, Gweru, Zimbabwe
| | - Anifa Valá
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | - Laura A Magee
- School of Life Course Sciences, King's Collage London, Strand, London, UK
| | | | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique.,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique. .,Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
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7
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Pham TV, Koirala R, Kohrt BA. Traditional and biomedical care pathways for mental well-being in rural Nepal. Int J Ment Health Syst 2021; 15:4. [PMID: 33413540 PMCID: PMC7792081 DOI: 10.1186/s13033-020-00433-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/22/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care. METHODS We conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach. RESULTS A majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers. CONCLUSION Participants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.
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Affiliation(s)
- Tony V Pham
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States
| | - Rishav Koirala
- Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Kathmandu, 44616, Nepal.
- University of Oslo, Problemveien 7, Oslo, 0315, Norway.
| | - Brandon A Kohrt
- Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States
- Brain and Neuroscience Center Nepal, Krishna Dhara Marg, Kathmandu, 44600, Nepal
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, 2120 L Street, NW, Suite 600, Washington, DC, 20037, United States
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8
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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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Popping S, Bade D, Boucher C, van der Valk M, El-Sayed M, Sigurour O, Sypsa V, Morgan T, Gamkrelidze A, Mukabatsinda C, Deuffic-Burban S, Ninburg M, Feld J, Hellard M, Ward J. The global campaign to eliminate HBV and HCV infection: International Viral Hepatitis Elimination Meeting and core indicators for development towards the 2030 elimination goals. J Virus Erad 2019; 5:60-66. [PMID: 30800429 PMCID: PMC6362901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) affect more than 320 million people worldwide, which is more than HIV, tuberculosis (TB) and malaria combined. Elimination of HBV and HCV will, therefore, produce substantial public health and economic benefits and, most importantly, the prevention of 1.2 million deaths per year. In 2016, member states of the World Health Assembly unanimously adopted a resolution declaring that viral hepatitis should be eliminated by 2030. Currently, few countries have elimination programmes in place and even though the tools to achieve elimination are available, the right resources, commitments and allocations are lacking. During the fifth International Viral Hepatitis Elimination Meeting (IVHEM), 7-8 December 2018, Amsterdam, the Netherlands, an expert panel of clinicians, virologists and public health specialists discussed the current status of viral hepatitis elimination programmes across multiple countries, challenges in achieving elimination and the core indicators for monitoring progress, approaches that have failed and successful elimination plans.
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Affiliation(s)
- Stephanie Popping
- Department of Viroscience, Erasmus Medical Center,
Erasmus University,
Rotterdam,
the Netherlands
| | - Debora Bade
- Virology Education,
Utrecht,
the Netherlands
| | - Charles Boucher
- Department of Viroscience, Erasmus Medical Center,
Erasmus University,
Rotterdam,
the Netherlands
- Virology Education,
Utrecht,
the Netherlands
| | | | - Manal El-Sayed
- Department of Pediatrics,
Ain Shams University,
Cairo,
Egypt
| | - Olafsson Sigurour
- Division of Gastroenterology,
Department of Medicine,
Landspitali University Hospital,
Reykjavik,
Iceland
| | - Vana Sypsa
- Department of Hygiene,
Epidemiology and Medical Statistics,
Medical School,
National and Kapodistrian University of Athens,
Greece
| | - Timothy Morgan
- Gastroenterology Section,
VA Long Beach Healthcare System,
Long Beach,
CA,
USA
| | | | | | | | | | - Jordan Feld
- Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health,
University of Toronto,
Toronto,
Canada
| | - Margaret Hellard
- Disease Elimination Program,
Burnet Institute,
Melbourne,
Australia
| | - John Ward
- National Center for HIV,
Viral Hepatitis,
STD, and TB, CDC,
Atlanta,
GA,
USA
- Task Force for Global Health, Decatur,
Atlanta,
GA,
USA
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10
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Popping S, Bade D, Boucher C, van der Valk M, El-Sayed M, Sigurour O, Sypsa V, Morgan T, Gamkrelidze A, Mukabatsinda C, Deuffic-Burban S, Ninburg M, Feld J, Hellard M, Ward J. The global campaign to eliminate HBV and HCV infection: International Viral Hepatitis Elimination Meeting and core indicators for development towards the 2030 elimination goals. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30281-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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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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12
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Maleke K, Daniels J, Lane T, Struthers H, McIntyre J, Coates T. How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa. Glob Health Promot 2017; 26:6-13. [PMID: 29168662 DOI: 10.1177/1757975917737509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.
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Affiliation(s)
| | - Joseph Daniels
- Department of Health Sciences, Lehman College of CUNY, New York, NY, USA
| | - Tim Lane
- Center for AIDS Prevention Science, UCSF, San Francisco, CA, USA
| | | | | | - Thomas Coates
- Center for World Health, David Geffen School of Medicine, UCLA Los Angeles, CA, USA
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Audet CM, Salato J, Vermund SH, Amico KR. Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique. Implement Sci 2017. [PMID: 28407813 DOI: 10.1186/s13012-017-0582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Systematic adaptation of evidence-informed interventions that increase retention in care and improve adherence to antiretroviral therapy (ART) are essential to ending the HIV epidemic in rural sub-Saharan Africa. We selected and adapted an adherence support worker intervention employed in Malawi for use by traditional healers in rural Mozambique. Given the levels of trust and dependence previously expressed by persons living with HIV (PLHIV) for traditional medicine, we adapted the program to engage traditional healers within the allopathic health system. METHODS Adaption followed a theoretically driven approach to intervention adaption: the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) model. Three rounds of performance feedback, based on theater presentations of the adapted intervention for stakeholders and idea generation, were completed with 12 groups from March to July 2016 to develop the final model. We offered healer support to 180 newly diagnosed HIV-infected patients. RESULTS Traditional healers were an acceptable group of community health workers to assist with patient adherence and retention. Traditional healers, clinicians, and interested community members suggested novel strategies to tailor the adherence support worker intervention, revealing a local culture of HIV denialism, aversion to the health system, and dislike of healthcare providers, as well as a preference for traditional treatments. Proposed changes to the intervention included modifications to the training language and topics, expanded community-based activities to support acceptability of an HIV diagnosis and to facilitate partner disclosure, and accompaniment to the health facility by healers to encourage delivery of respectful clinical care. PLHIV, healers, and clinicians deemed the intervention socially acceptable during focus groups. We subsequently recruited 180 newly diagnosed HIV-infected patients into the program: 170 (94%) accepted. CONCLUSIONS Systematic translation of interventions, even between regions with similar social and economic environments, is an important first step to successful program implementation. Efforts previously limited to community health workers can be tailored for use by traditional healers-an underutilized and often maligned health workforce. It proved feasible to use theater-based performances to demonstrate delivery of the intervention in low-literacy populations, generating discussions about social norms, community concerns, and the merits of an acceptable strategy to improve retention and adherence to ART.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Departments of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - José Salato
- Friends in Global Health, Quelimane, Mozambique
- Friends in Global Health, Maputo, Mozambique
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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14
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Audet CM, Salato J, Vermund SH, Amico KR. Adapting an adherence support workers intervention: engaging traditional healers as adherence partners for persons enrolled in HIV care and treatment in rural Mozambique. Implement Sci 2017; 12:50. [PMID: 28407813 PMCID: PMC5390357 DOI: 10.1186/s13012-017-0582-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 04/06/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Systematic adaptation of evidence-informed interventions that increase retention in care and improve adherence to antiretroviral therapy (ART) are essential to ending the HIV epidemic in rural sub-Saharan Africa. We selected and adapted an adherence support worker intervention employed in Malawi for use by traditional healers in rural Mozambique. Given the levels of trust and dependence previously expressed by persons living with HIV (PLHIV) for traditional medicine, we adapted the program to engage traditional healers within the allopathic health system. METHODS Adaption followed a theoretically driven approach to intervention adaption: the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing (ADAPT-ITT) model. Three rounds of performance feedback, based on theater presentations of the adapted intervention for stakeholders and idea generation, were completed with 12 groups from March to July 2016 to develop the final model. We offered healer support to 180 newly diagnosed HIV-infected patients. RESULTS Traditional healers were an acceptable group of community health workers to assist with patient adherence and retention. Traditional healers, clinicians, and interested community members suggested novel strategies to tailor the adherence support worker intervention, revealing a local culture of HIV denialism, aversion to the health system, and dislike of healthcare providers, as well as a preference for traditional treatments. Proposed changes to the intervention included modifications to the training language and topics, expanded community-based activities to support acceptability of an HIV diagnosis and to facilitate partner disclosure, and accompaniment to the health facility by healers to encourage delivery of respectful clinical care. PLHIV, healers, and clinicians deemed the intervention socially acceptable during focus groups. We subsequently recruited 180 newly diagnosed HIV-infected patients into the program: 170 (94%) accepted. CONCLUSIONS Systematic translation of interventions, even between regions with similar social and economic environments, is an important first step to successful program implementation. Efforts previously limited to community health workers can be tailored for use by traditional healers-an underutilized and often maligned health workforce. It proved feasible to use theater-based performances to demonstrate delivery of the intervention in low-literacy populations, generating discussions about social norms, community concerns, and the merits of an acceptable strategy to improve retention and adherence to ART.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Departments of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - José Salato
- Friends in Global Health, Quelimane, Mozambique.,Friends in Global Health, Maputo, Mozambique
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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15
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Ngunyulu RN, Peu MD, Mulaudzi FM, Mataboge MLS, Phiri SS. Collaborative HIV care in primary health care: nurses' views. Int Nurs Rev 2017; 64:561-567. [PMID: 28181218 DOI: 10.1111/inr.12359] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. AIM To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. METHOD A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. RESULTS Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. DISCUSSION The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. CONCLUSION It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. IMPLICATIONS FOR NURSING AND HEALTH POLICY Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care.
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Affiliation(s)
- R N Ngunyulu
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - M D Peu
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - F M Mulaudzi
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - M L S Mataboge
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
| | - S S Phiri
- Department of Nursing Sciences, University of Pretoria, Pretoria, South Africa
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16
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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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Leclerc-Madlala S, Green E, Hallin M. Traditional healers and the "Fast-Track" HIV response: is success possible without them? AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:185-93. [PMID: 27399048 DOI: 10.2989/16085906.2016.1204329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rapid scale-up of effective HIV prevention strategies is a central theme of the post-2015 health and development agenda. All major global HIV and AIDS funders have aligned their policies and plans to achieve sharp reductions in new HIV infections and reach epidemic control by 2030. In these "fast-track" plans, increased antiretroviral treatment coverage and the attainment of viral suppression are pivotal, and there is firm recognition of the need for countries to mobilise more domestic resources and build stronger community clinic systems. There is little in these bold plans, however, to suggest that the now 30-year-old call by the World Health Organization (WHO) and other organisations to establish systematic collaborations with the traditional health sector will finally be heeded. In the context of sub-Saharan Africa's HIV epidemic, a significant body of literature demonstrates the critical role that traditional healers can play in improving the success of health programmes, including those for HIV prevention. This paper provides a brief history of collaboration with traditional healers for HIV followed by a description of several successful collaborations and discussion of key elements for success. We argue that the traditional health sector is a major resource that has yet to be sufficiently mobilised against HIV. As we shift from a short-term HIV response to a longer-term and more sustainable response, there is an urgent need to accelerate efforts to leverage and partner with the hundreds of thousands of traditional health practitioners who are already providing health services in communities. Failure to better attune our work to the medical pluralism of communities affected by HIV will continue to hinder HIV programming success and help assure that ambitious post-2015 HIV prevention and control goals are not realised.
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Affiliation(s)
- Suzanne Leclerc-Madlala
- a Office of HIV and AIDS, Global Health Bureau , US Agency for International Development , Washington , DC , USA
| | - Edward Green
- b Department of Anthropology , The George Washington University , Washington , DC , USA
| | - Mary Hallin
- c College of Business Administration , University of Nebraska at Omaha , Omaha , Nebraska , USA
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Musyimi CW, Mutiso VN, Nandoya ES, Ndetei DM. Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2016; 12:4. [PMID: 26742992 PMCID: PMC4705751 DOI: 10.1186/s13002-015-0075-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/21/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Qualitative evidence on dialogue formation and collaboration is very scanty in Kenya. This study thus aimed at the formation of dialogue and establishment of collaboration among the informal (faith and traditional healers) and formal health workers (clinicians) in enhancing community-based mental health in rural Kenya. METHODS Qualitative approach was used to identify barriers and solutions for dialogue formation by conducting nine Focus Group Discussions each consisting of 8-10 participants. Information on age, gender and role in health care setting as well as practitioners' (henceforth used to mean informal (faith and traditional healers) and formal health workers) perceptions on dialogue was collected to evaluate dialogue formation. Qualitative and quantitative data analysis was performed using thematic content analysis and Statistical Package Social Sciences (SPSS) software respectively. RESULTS We identified four dominant themes such as; (i) basic understanding about mental illnesses, (ii) interaction and treatment skills of the respondents to mentally ill persons, (iii) referral gaps and mistrust among the practitioners and (iv) dialogue formation among the practitioners. Although participants were conversant with the definition of mental illness and had interacted with a mentally ill person in their routine practice, they had basic information on the causes and types of mental illness. Traditional and faith healers felt demeaned by the clinicians who disregarded their mode of treatment stereotyping them as "dirty". After various discussions, majority of practitioners showed interest in collaborating with each other and stated that they had joined the dialogue in order interact with people committed to improving the lives of patients. CONCLUSION Dialogue formation between the formal and the informal health workers is crucial in establishing trust and respect between both practitioners and in improving mental health care in Kenya. This approach could be scaled up among all the registered traditional and faith healers in Kenya.
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Affiliation(s)
- Christine W Musyimi
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Victoria N Mutiso
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Erick S Nandoya
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - David M Ndetei
- University of Nairobi and Founding Director Africa Mental Health Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya.
- University of Nairobi, Nairobi, Kenya.
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Vermund SH, Sheldon EK, Sidat M. Southern Africa: the Highest Priority Region for HIV Prevention and Care Interventions. Curr HIV/AIDS Rep 2015; 12:191-5. [PMID: 25869940 PMCID: PMC4536916 DOI: 10.1007/s11904-015-0270-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The global HIV pandemic began to expand rapidly in southern Africa a decade later than was noted in central Africa, Europe, the Caribbean, and North America. Multiple factors played a role in this rapid expansion which led Southern Africa to become the most heavily afflicted region for HIV/AIDS globally. In this issue of Current HIV/AIDS Reports, investigators with active research interests in the region have reviewed key elements of the causes of and responses to the epidemic. Putative causes of the high HIV prevalence in the region are discussed, including host and viral biology, human behavior, politics and policy, structural factors, health services, health workforce, migration, traditional healers' role, and other issues. Regional epidemiological trends are described and forecasted. Issues related to the continuum of HIV care and treatment are highlighted. We hope that the reviews will prove useful to those policymakers, health care workers, and scientists who are striving to reduce the burden of HIV in the southern African region, as well as prove insightful for key issues of broader global relevance.
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Affiliation(s)
- Sten H Vermund
- Vanderbilt Institute of Global Health, Vanderbilt University School of Medicine, 2525 West End Ave., Suite 750, Nashville, TN, 37203, USA,
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