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

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  • 1 Department of Medicine, University of Washington, Seattle, Washington;
  • | 2 Centre de Santé de Ziguinchor, Ziguinchor, Senegal;
  • | 3 Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal;
  • | 4 Centre de Santé de Bignona, Bignona, Senegal;
  • | 5 Division de Lutte contre le Sida et les Infections Sexuellement Transmissibles, Ministère de la Santé et de l’Action Sociale, Dakar, Senegal;
  • | 6 Department of Epidemiology, University of Washington, Seattle, Washington;
  • | 7 Department of Global Health, University of Washington, Seattle, Washington

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.

Author Notes

Address correspondence to Noelle A. Benzekri, Department of Medicine, University of Washington, Box 358061, 750 Republican Street, Seattle, WA 98109-4725. E-mail: benzekri@uw.edu

Financial support: This study was supported by the NIH-NIAID (grant number K23 AI120761 to N.A.B.). The funding body had no role in the design of the study, collection, analysis, or interpretation of data, or in writing the manuscript.

Disclosure: N.A.B. receives research support from the US National Institutes of Health. G.S.G. has received research grants and research support from the US National Institutes of Health, University of Washington, Bill and Melinda Gates Foundation, Gilead Sciences, Alere Technologies, Merck & Co., Inc., Janssen Pharmaceutica, Cerus Corporation, ViiV Healthcare, Bristol-Myers Squibb, Thera technologies/TAI Med Biologics, and Abbott Molecular Diagnostics. P.S.S. is currently employed at Gilead Sciences. S.E.H. has received research grants and support from the US National Institutes of Health, University of Washington, and Bill and Melinda Gates Foundation. All other authors have nothing to declare.

Authors’ addresses: Noelle A. Benzekri, Department of Medicine, University of Washington, Seattle, WA, E-mail: benzekri@uw.edu. Jacques F. Sambou, Ousseynou Cisse, and Jean Jacques Malomar, Centre de Santé de Ziguinchor, Ziguinchor, Senegal. Sanou Ndong, Mouhamadou Baïla Diallo, Dominique Faye, Ibrahima Sall, and Jean Philippe Diatta, Centre de Sante de Ziguinchor, Ziguinchor, Senegal NOT Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal. Khadim Faye, Fatima Sall, Papa Salif Sow, and Moussa Seydi, Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal. Ibrahima Tito Tamba, Centre de Santé de Bignona, Bignona, Senegal. Cheikh T. Ndour, Division de Lutte contre le Sida et les Infections Sexuellement Transmissibles, Ministère de la Santé et de l’Action Sociale, Dakar, Senegal. Stephen E. Hawes, Department of Epidemiology, Department of Global Health, University of Washington, Seattle, WA. Geoffrey S. Gottlieb, Department of Medicine and Department of Global Health, University of Washington, Seattle, WA.

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