NDLI: Symptomatic HIV-positive persons in rural Mozambique who first consult a traditional healer have delays in HIV testing: a cross-sectional study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Audet, Carolyn M. Blevins, Meridith Rosenberg, Caitlin Farnsworth, Sarah Salato, José Fernandez, Jorge Vermund, Sten H.
Spatial Coverage	Mozambique
Description	Country affiliation: Tunisia Author Affiliation: Audet CM ( *Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN)
Abstract	OBJECTIVE: Delays in HIV diagnosis and initiation of antiretroviral therapy are common even among symptomatic individuals in Africa. We hypothesized that antiretroviral therapy delays might be more common if traditional healers (THs) were the first practitioners consulted. DESIGN: Cross-sectional study. METHODS: We interviewed 530 newly diagnosed HIV-infected adults (≥18 years of age) who were clinically symptomatic at the time of HIV testing in 2 rural districts in Zambézia Province, Mozambique. We ascertained their previous health care seeking behavior, duration of their symptoms, CD4 cell counts at the time of entry into care, and treatment provided by TH(s). RESULTS: Of 517 patients (97.5%) with complete histories, 62% sought care from a healer before presenting to the local health facility. The median time to first health facility visit from first relevant symptom was 2 months [interquartile range (IQR): 1-4.5] for persons who had not visited a healer, 3 months (IQR: 2-6) for persons visiting 1 healer, and 9 months (IQR: 5-12) for persons visiting >1 healer (P < 0.001). Healers diagnosed 56% of patients with a social or ancestral curse and treated 66% with subcutaneous herbal remedies. A nonsignificant trend toward lower CD4 cells for persons who had seen multiple healers was noted. CONCLUSIONS: Seeking initial care from healers was associated with delays in HIV testing among symptomatic HIV-seropositive persons. We had no CD4 evidence that sicker patients bypass THs, a potential inferential bias. Engaging THs in a therapeutic alliance may facilitate the earlier diagnosis of HIV/AIDS.
File Format	HTM / HTML
ISSN	15254135
e-ISSN	10779450
DOI	10.1097/QAI.0000000000000194
Journal	JAIDS Journal of Acquired Immune Deficiency Syndromes
Issue Number	4
Volume Number	66
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2014-08-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline AIDS Hiv Infections Diagnosis Therapy Medicine, African Traditional Cross-sectional Studies Epidemiology Mozambique Rural Population Time Factors Research Support, U.s. Gov't, P.h.s.
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology (medical)

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