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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Symptomatic HIV-positive persons in rural mozambique who first consult a traditional healer have delays in HIV testing: A cross-sectional study
Journal of Acquired Immune Deficiency Syndromes, Volume 66, No. 4, Year 2014
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Description
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. Copyright © 2014 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Audet, Carolyn M.
United States, Nashville
Vanderbilt University Medical Center
United States, Nashville
Vanderbilt University School of Medicine
Blevins, Meridith L.
United States, Nashville
Vanderbilt University School of Medicine
Rosenberg, Caitlin
Unknown Affiliation
Farnsworth, Sarah
Unknown Affiliation
Salato, José
Mozambique, Quelimane
Friends in Global Health
Fernandez, Jorge
Mozambique, Quelimane
Friends in Global Health
Vermund, Sten Havlor
United States, Nashville
Vanderbilt University Medical Center
Mozambique, Quelimane
Friends in Global Health
United States, Nashville
Vanderbilt University School of Medicine
Statistics
Citations: 44
Authors: 7
Affiliations: 3
Identifiers
Doi:
10.1097/QAI.0000000000000194
ISSN:
15254135
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Mozambique