Cargando…

Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial

BACKGROUND: HIV counselling and testing are essential to control the HIV epidemic. However, HIV testing uptake is low in sub-Saharan Africa, where many people use informal health-care resources such as traditional healers. We hypothesised that uptake of HIV tests would increase if provided by tradit...

Descripción completa

Detalles Bibliográficos
Autores principales: Sundararajan, Radhika, Ponticiello, Matthew, Lee, Myung Hee, Strathdee, Steffanie A, Muyindike, Winnie, Nansera, Denis, King, Rachel, Fitzgerald, Daniel, Mwanga-Amumpaire, Juliet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562591/
https://www.ncbi.nlm.nih.gov/pubmed/34678199
http://dx.doi.org/10.1016/S2214-109X(21)00366-1
_version_ 1784593283368878080
author Sundararajan, Radhika
Ponticiello, Matthew
Lee, Myung Hee
Strathdee, Steffanie A
Muyindike, Winnie
Nansera, Denis
King, Rachel
Fitzgerald, Daniel
Mwanga-Amumpaire, Juliet
author_facet Sundararajan, Radhika
Ponticiello, Matthew
Lee, Myung Hee
Strathdee, Steffanie A
Muyindike, Winnie
Nansera, Denis
King, Rachel
Fitzgerald, Daniel
Mwanga-Amumpaire, Juliet
author_sort Sundararajan, Radhika
collection PubMed
description BACKGROUND: HIV counselling and testing are essential to control the HIV epidemic. However, HIV testing uptake is low in sub-Saharan Africa, where many people use informal health-care resources such as traditional healers. We hypothesised that uptake of HIV tests would increase if provided by traditional healers. We aimed to determine the effectiveness of traditional healers delivering HIV testing at point of care compared with referral to local clinics for HIV testing in rural southwestern Uganda. METHODS: We did a mixed-methods study that included a cluster-randomised trial followed by individual qualitative interviews among a sample of participants in Mbarara, Uganda. Traditional healers aged 18 years or older who were located within 8 km of the Mbarara District HIV clinic, were identified in the 2018 population-level census of traditional healers in Mbarara District, and delivered care to at least seven clients per week were randomly assigned (1:1) as clusters to an intervention or a control group. Healers screened their clients for eligibility, and research assistants confirmed eligibility and enrolled clients who were aged 18 years or older, were receiving care from a participating healer, were sexually active (ever had intercourse), self-reported not having received an HIV test in the previous 12 months (and therefore considered to be of unknown serostatus), and had not previously been diagnosed with HIV infection. Intervention group healers provided counselling and offered point-of-care HIV tests to adult clients. Control group healers provided referral for HIV testing at nearby clinics. The primary outcome was the individual receipt of an HIV test within 90 days of study enrolment. Safety and adverse events were recorded and defined on the basis of prespecified criteria. This study is registered with ClinicalTrials.gov, NCT03718871. FINDINGS: Between Aug 2, 2019, and Feb 7, 2020, 17 traditional healers were randomly assigned as clusters (nine to intervention and eight to control), with 500 clients of unknown HIV serostatus enrolled (250 per group). In the intervention group, 250 clients (100%) received an HIV test compared with 57 (23%) in the control group, a 77% (95% CI 73–82) increase in testing uptake, after adjusting for the effect of clustering (p<0·0001). Ten (4%) of 250 clients in the intervention group tested HIV positive, seven of whom self-reported linkage to HIV care. No new HIV cases were identified in the control group. Qualitative interviews revealed that HIV testing delivered by traditional healers was highly acceptable among both providers and clients. No safety or adverse events were reported. INTERPRETATION: Delivery of point-of-care HIV tests by traditional healers to adults of unknown serostatus significantly increased rates of HIV testing in rural Uganda. Given the ubiquity of healers in Africa, this approach holds promise as a new pathway to provide community-based HIV testing, and could have a dramatic effect on uptake of HIV testing in sub-Saharan Africa. FUNDING: US National Institute of Mental Health, National Institutes of Health.
format Online
Article
Text
id pubmed-8562591
institution National Center for Biotechnology Information
language English
publishDate 2021
record_format MEDLINE/PubMed
spelling pubmed-85625912021-11-02 Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial Sundararajan, Radhika Ponticiello, Matthew Lee, Myung Hee Strathdee, Steffanie A Muyindike, Winnie Nansera, Denis King, Rachel Fitzgerald, Daniel Mwanga-Amumpaire, Juliet Lancet Glob Health Article BACKGROUND: HIV counselling and testing are essential to control the HIV epidemic. However, HIV testing uptake is low in sub-Saharan Africa, where many people use informal health-care resources such as traditional healers. We hypothesised that uptake of HIV tests would increase if provided by traditional healers. We aimed to determine the effectiveness of traditional healers delivering HIV testing at point of care compared with referral to local clinics for HIV testing in rural southwestern Uganda. METHODS: We did a mixed-methods study that included a cluster-randomised trial followed by individual qualitative interviews among a sample of participants in Mbarara, Uganda. Traditional healers aged 18 years or older who were located within 8 km of the Mbarara District HIV clinic, were identified in the 2018 population-level census of traditional healers in Mbarara District, and delivered care to at least seven clients per week were randomly assigned (1:1) as clusters to an intervention or a control group. Healers screened their clients for eligibility, and research assistants confirmed eligibility and enrolled clients who were aged 18 years or older, were receiving care from a participating healer, were sexually active (ever had intercourse), self-reported not having received an HIV test in the previous 12 months (and therefore considered to be of unknown serostatus), and had not previously been diagnosed with HIV infection. Intervention group healers provided counselling and offered point-of-care HIV tests to adult clients. Control group healers provided referral for HIV testing at nearby clinics. The primary outcome was the individual receipt of an HIV test within 90 days of study enrolment. Safety and adverse events were recorded and defined on the basis of prespecified criteria. This study is registered with ClinicalTrials.gov, NCT03718871. FINDINGS: Between Aug 2, 2019, and Feb 7, 2020, 17 traditional healers were randomly assigned as clusters (nine to intervention and eight to control), with 500 clients of unknown HIV serostatus enrolled (250 per group). In the intervention group, 250 clients (100%) received an HIV test compared with 57 (23%) in the control group, a 77% (95% CI 73–82) increase in testing uptake, after adjusting for the effect of clustering (p<0·0001). Ten (4%) of 250 clients in the intervention group tested HIV positive, seven of whom self-reported linkage to HIV care. No new HIV cases were identified in the control group. Qualitative interviews revealed that HIV testing delivered by traditional healers was highly acceptable among both providers and clients. No safety or adverse events were reported. INTERPRETATION: Delivery of point-of-care HIV tests by traditional healers to adults of unknown serostatus significantly increased rates of HIV testing in rural Uganda. Given the ubiquity of healers in Africa, this approach holds promise as a new pathway to provide community-based HIV testing, and could have a dramatic effect on uptake of HIV testing in sub-Saharan Africa. FUNDING: US National Institute of Mental Health, National Institutes of Health. 2021-11 /pmc/articles/PMC8562591/ /pubmed/34678199 http://dx.doi.org/10.1016/S2214-109X(21)00366-1 Text en https://creativecommons.org/licenses/by/4.0/This is an Open Access article under the CC BY 4.0 license.
spellingShingle Article
Sundararajan, Radhika
Ponticiello, Matthew
Lee, Myung Hee
Strathdee, Steffanie A
Muyindike, Winnie
Nansera, Denis
King, Rachel
Fitzgerald, Daniel
Mwanga-Amumpaire, Juliet
Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial
title Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial
title_full Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial
title_fullStr Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial
title_full_unstemmed Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial
title_short Traditional healer-delivered point-of-care HIV testing versus referral to clinical facilities for adults of unknown serostatus in rural Uganda: a mixed-methods, cluster-randomised trial
title_sort traditional healer-delivered point-of-care hiv testing versus referral to clinical facilities for adults of unknown serostatus in rural uganda: a mixed-methods, cluster-randomised trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562591/
https://www.ncbi.nlm.nih.gov/pubmed/34678199
http://dx.doi.org/10.1016/S2214-109X(21)00366-1
work_keys_str_mv AT sundararajanradhika traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT ponticiellomatthew traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT leemyunghee traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT strathdeesteffaniea traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT muyindikewinnie traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT nanseradenis traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT kingrachel traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT fitzgeralddaniel traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial
AT mwangaamumpairejuliet traditionalhealerdeliveredpointofcarehivtestingversusreferraltoclinicalfacilitiesforadultsofunknownserostatusinruralugandaamixedmethodsclusterrandomisedtrial