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. 2021 Aug 23;105(5):1290-1297.
doi: 10.4269/ajtmh.21-0280.

Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study

Noelle A Benzekri  1 , Jacques F Sambou  2 , Sanou Ndong  3 , Mouhamadou Baïla Diallo  3 , Ibrahima Tito Tamba  4 , Dominique Faye  2 , Ibrahima Sall  2 , Jean Philippe Diatta  2 , Khadim Faye  3 , Fatima Sall  3 , Ousseynou Cisse  2 , Cheikh T Ndour  5 , Papa Salif Sow  3 , Jean Jacques Malomar  2 , Stephen E Hawes  6   7 , Moussa Seydi  3 , Geoffrey S Gottlieb  6   7
Affiliations

Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study

Noelle A Benzekri et al. Am J Trop Med Hyg. .

Abstract

Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was "mystical" concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22-45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25-9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12-8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.

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Figures

Figure 1.
Figure 1.
Participant-reported reasons for consulting a traditional healer. (A) Some participants provided more than one reason; therefore, the sum is greater than 100%. (B) Mystical concerns include mystical problems, mystical treatments, bad spirits, spiritual offerings, protective washing, and rituals. (C) Median time interval between the last consultation with a traditional healer and visit to the HIV clinic: 2 months (interquartile range [IQR], 1-5 months). HA, headache; Neuro, dizziness and numbness; Abd, abdominal; Other Pain, joint pain and diffuse pain; Hem, hemorrhoids; Sleep Dist, sleep disturbance including nightmares and insomnia.
Figure 2.
Figure 2.
Outcomes according to consultation with a traditional healer (TH) prior to ART or during follow-up versus did not consult a TH.
See this image and copyright information in PMC

References

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    1. UNAIDS , 2000. Collaboration with Traditional Healers in HIV/AIDS Prevention and Care in Sub-Saharan Africa A Literature Review. King, R. Geneva Switzerland, September 2000. Available at: data.unaids.org/publications/irc-pub01/jc299-tradheal_en.pdf.
    1. Regional Committee for Africa , 2011. Progress Report on Decade of Traditional Medicine in the African Region: Progress Report. World Health Organization, Regional Office for Africa. Available at: https://apps.who.int/iris/handle/10665/336704.
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    1. UNAIDS , 2006. Collaborating with Traditional Healers for HIV Prevention and Care in Sub-Saharan Africa: Practical Guidelines for Programmes. UNAIDS best practice collection “UNAIDS/06.28E.” Available at: data.unaids.org/publications/irc-pub07/jc967-tradhealers_en.pdf.

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