AIDS and Behavior

, Volume 17, Issue 1, pp 260–265

No Association Found Between Traditional Healer Use and Delayed Antiretroviral Initiation in Rural Uganda

  • Russell H. Horwitz
  • Alexander C. Tsai
  • Samuel Maling
  • Francis Bajunirwe
  • Jessica E. Haberer
  • Nneka Emenyonu
  • Conrad Muzoora
  • Peter W. Hunt
  • Jeffrey N. Martin
  • David R. Bangsberg
Brief Report

Abstract

Traditional healer and/or spiritual counselor (TH/SC) use has been associated with delays in HIV testing. We examined HIV-infected individuals in southwestern Uganda to test the hypothesis that TH/SC use was also associated with lower CD4 counts at antiretroviral therapy (ART) initiation. Approximately 450 individuals initiating ART through an HIV/AIDS clinic at the Mbarara University of Science and Technology (MUST) were recruited to participate. Patients were predominantly female, ranged in age from 18 to 75, and had a median CD4 count of 130. TH/SC use was not associated with lower CD4 cell count, but age and quality-of-life physical health summary score were associated with CD4 cell count at initiation while asset index was negatively associated with CD4 count at ART initiation. These findings suggest that TH/SC use does not delay initiation of ART.

Keywords

HIV/AIDS Traditional healer Spiritual counselor Late presentation Uganda 

Resumen

La consulta con un curandero tradicional y/o consejero espiritual (TH/SC) ha sido asociada a retrasos para someterse a la prueba de VIH. Evaluamos personas con VIH en el sudoeste de Uganda para poner a prueba la hipótesis de que consultar con un TH/SC también está asociado a un conteo bajo de células CD4 al inicio de una terapia antirretroviral (ART). Se reclutó aproximadamente 450 personas iniciando ART en una clínica de VIH/SIDA en la Universidad de Mbarara de Ciencia y Tecnología (MUST). Los pacientes fueron predominantemente mujeres, entre las edades de 18 y 75, cuyo recuento mediano de CD4 estaba en 130. Se encontró que la consulta con un TH/SC no está asociada a un recuento menor de células CD4. Sin embargo, la edad y la calidad de vida física sí se encontraron asociados al recuento de células CD4 al inicio. En contraste, el índice-de-recurso se encontró asociado negativamente con el recuento de CD4 al inicio del ART. Estos hallazgos sugieren que la consulta con un TH/SC no resulta en un atraso para iniciar la ART.

References

  1. 1.
    Girardi E, Sabin CA, Monforte AD. Late diagnosis of HIV infection: epidemiological features, consequences and strategies to encourage earlier testing. J Acquir Immune Defic Syndr. 2007;46(Suppl 1):S3–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Brinkhof MW, Boulle A, Weigel R, Messou E, Mathers C, Orrell C, et al. Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. PLoS Med. 2009;6(4):e1000066.PubMedCrossRefGoogle Scholar
  3. 3.
    May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, et al. Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 2010;376(9739):449–57.PubMedCrossRefGoogle Scholar
  4. 4.
    Puckree T, Mkhize M, Mgobhozi Z, Lin J. African traditional healers: what health care professionals need to know. Int J Rehabil Res. 2002;25(4):247–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Homsy J, King R, Balaba D, Kabatesi D. Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. AIDS. 2004;18(12):1723–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Mills E, Singh S, Wilson K, Peters E, Onia R, Kanfer I. The challenges of involving traditional healers in HIV/AIDS care. Int J STD AIDS. 2006;17(6):360–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Traditional medicine - growing needs and potential: WHO Policy Perspectives on Medicines. Geneva, Switzerland: World Health Organization 2002 May 2.Google Scholar
  8. 8.
    Malik IA, Gopalan S. Use of CAM results in delay in seeking medical advice for breast cancer. Eur J Epidemiol. 2003;18(8):817–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005;5:112.PubMedCrossRefGoogle Scholar
  10. 10.
    Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. 2008;8:15.PubMedCrossRefGoogle Scholar
  11. 11.
    Kigozi IM, Dobkin LM, Martin JN, Geng EH, Muyindike W, Emenyonu NI, et al. Late-disease stage at presentation to an HIV clinic in the era of free antiretroviral therapy in Sub-Saharan Africa. J Acquir Immune Defic Syndr. 2009;52(2):280–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Begovac J, Gedike K, Lukas D, Lepej SZ. Late presentation to care for HIV infection in Croatia and the effect of interventions during the Croatian Global Fund Project. AIDS Behav. 2008;12(4 Suppl):S48–53.PubMedCrossRefGoogle Scholar
  13. 13.
    de Olalla PG, Mazardo C, Sambeat MA, Ocana I, Knobel H, Humet V, et al. Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001–2009. AIDS Res Ther. 2011;8(1):22.PubMedCrossRefGoogle Scholar
  14. 14.
    Bonjour MA, Montagne M, Zambrano M, Molina G, Lippuner C, Wadskier FG, et al. Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: a case–case comparison. AIDS Res Ther. 2008;5:6.PubMedCrossRefGoogle Scholar
  15. 15.
    Lo YC, Wu PY, Hsieh CY, Chen MY, Sheng WH, Hsieh SM, et al. Late diagnosis of human immunodeficiency virus infection in the era of highly active antiretroviral therapy: role of socio-behavioral factors and medical encounters. J Formos Med Assoc. 2011;110(5):306–15.PubMedCrossRefGoogle Scholar
  16. 16.
    Okome-Nkoumou M, Okome-Miame F, Kendjo E, Obiang GP, Kouna P, Essola-Biba O, et al. Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville. Gabon. HIV Clin Trials. 2005;6(1):38–42.CrossRefGoogle Scholar
  17. 17.
    Wanyenze RK, Kamya MR, Fatch R, Mayanja-Kizza H, Baveewo S, Sawires S, et al. Missed opportunities for HIV testing and late-stage diagnosis among HIV-infected patients in Uganda. PLoS One. 2011;6(7):e21794.PubMedCrossRefGoogle Scholar
  18. 18.
    Louis C, Ivers LC, Smith Fawzi MC, Freedberg KA, Castro A. Late presentation for HIV care in central Haiti: factors limiting access to care. AIDS Care. 2007;19(4):487–91.PubMedCrossRefGoogle Scholar
  19. 19.
    Girardi E, Aloisi MS, Arici C, Pezzotti P, Serraino D, Balzano R, et al. Delayed presentation and late testing for HIV: demographic and behavioral risk factors in a multicenter study in Italy. J Acquir Immune Defic Syndr. 2004;36(4):951–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Samet JH, Freedberg KA, Stein MD, Lewis R, Savetsky J, Sullivan L, et al. Trillion virion delay: time from testing positive for HIV to presentation for primary care. Arch Intern Med. 1998;158(7):734–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Geng EH, Bwana MB, Kabakyenga J, Muyindike W, Emenyonu NI, Musinguzi N, et al. Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda. PLoS One. 2010;5(11):e14098.PubMedCrossRefGoogle Scholar
  22. 22.
    Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the medical outcomes study HIV health survey (MOS-HIV). Qual Life Res. 1997;6(6):481–93.PubMedCrossRefGoogle Scholar
  23. 23.
    Wu AW, Rubin HR, Mathews WC, Ware JE Jr, Brysk LT, Hardy WD, et al. A health status questionnaire using 30 items from the medical outcomes study. preliminary validation in persons with early HIV infection. Med Care. 1991;29(8):786–98.PubMedCrossRefGoogle Scholar
  24. 24.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedCrossRefGoogle Scholar
  25. 25.
    Revicki DA, Sorensen S, Wu AW. Reliability and validity of physical and mental health summary scores from the medical outcomes study HIV health survey. Med Care. 1998;36(2):126–37.PubMedCrossRefGoogle Scholar
  26. 26.
    Mast TC, Kigozi G, Wabwire-Mangen F, Black R, Sewankambo N, Serwadda D, et al. Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, Uganda. AIDS Care. 2004;16(1):81–94.PubMedCrossRefGoogle Scholar
  27. 27.
    Stangl AL, Wamai N, Mermin J, Awor AC, Bunnell RE. Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda. AIDS Care. 2007;19(5):626–36.PubMedCrossRefGoogle Scholar
  28. 28.
    Bajunirwe F, Tisch DJ, King CH, Arts EJ, Debanne SM, Sethi AK. Quality of life and social support among patients receiving antiretroviral therapy in Western Uganda. AIDS Care. 2009;21(3):271–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Mollica RF, Wyshak G, de Marneffe D, Khuon F, Lavelle J. Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees. Am J Psychiatry. 1987;144(4):497–500.PubMedGoogle Scholar
  30. 30.
    McKelvey RS, Mao AR, Webb JA. Premigratory expectations and mental health symptomatology in a group of Vietnamese Amerasian youth. J Am Acad Child Adolesc Psychiatry. 1993;32(2):414–8.PubMedCrossRefGoogle Scholar
  31. 31.
    McKelvey RS, Webb JA, Mao AR. Premigratory risk factors in Vietnamese Amerasians. Am J Psychiatry. 1993;150(3):470–3.PubMedGoogle Scholar
  32. 32.
    Mouanoutoua VL, Brown LG. Hopkins Symptom Checklist-25, Hmong version: a screening instrument for psychological distress. J Pers Assess. 1995;64(2):376–83.PubMedCrossRefGoogle Scholar
  33. 33.
    Kaaya SF, Fawzi MC, Mbwambo JK, Lee B, Msamanga GI, Fawzi W. Validity of the Hopkins symptom checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106(1):9–19.PubMedCrossRefGoogle Scholar
  34. 34.
    Fillmore KM. Research as a handmaiden of policy: an appraisal of estimates of alcoholism and its cost in the workplace. J Public Health Policy. 1984;5(1):40–64.PubMedCrossRefGoogle Scholar
  35. 35.
    Hosmer DW, Lemeshow S. Applied logistic regression: Second Edition. New York City, NY: John Wiley & Sons, Inc; 2000.Google Scholar
  36. 36.
    Finnie RK, Khoza LB, van den Borne B, Mabunda T, Abotchie P, Mullen PD. Factors associated with patient and health care system delay in diagnosis and treatment for TB in sub-Saharan African countries with high burdens of TB and HIV. Trop Med Int Health. 2011;16(4):394–411.PubMedCrossRefGoogle Scholar
  37. 37.
    Warsame M, Kimbute O, Machinda Z, Ruddy P, Melkisedick M, Peto T, et al. Recognition, perceptions and treatment practices for severe malaria in rural Tanzania: implications for accessing rectal artesunate as a pre-referral. PLoS One. 2007;2(1):e149.PubMedCrossRefGoogle Scholar
  38. 38.
    Dye TD, Bogale S, Hobden C, Tilahun Y, Hechter V, Deressa T, et al. Complex care systems in developing countries: breast cancer patient navigation in Ethiopia. Cancer. 2010;116(3):577–85.PubMedCrossRefGoogle Scholar
  39. 39.
    Burns JK, Jhazbhay K, Emsley RA. Causal attributions, pathway to care and clinical features of first-episode psychosis: a South African perspective. Int J Soc Psychiatry. 2011;57(5):538–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Russell H. Horwitz
    • 1
    • 2
    • 14
  • Alexander C. Tsai
    • 3
  • Samuel Maling
    • 4
  • Francis Bajunirwe
    • 5
    • 6
  • Jessica E. Haberer
    • 7
    • 8
  • Nneka Emenyonu
    • 9
    • 10
  • Conrad Muzoora
    • 9
  • Peter W. Hunt
    • 10
    • 11
  • Jeffrey N. Martin
    • 12
  • David R. Bangsberg
    • 2
    • 7
    • 8
    • 9
    • 13
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Robert Wood Johnson Health and Society Scholars ProgramHarvard UniversityCambridgeUSA
  4. 4.Department of PsychiatryMbarara University of Science and TechnologyMbararaUganda
  5. 5.Department of Community HealthMbarara University of Science and TechnologyMbararaUganda
  6. 6.Department of Epidemiology and BiostatisticsCase Western Reserve UniversityClevelandUSA
  7. 7.Harvard Initiative for Global HealthCambridgeUSA
  8. 8.Center for Global HealthMassachusetts General HospitalBostonUSA
  9. 9.Department of MedicineMbarara University of Science and TechnologyMbararaUganda
  10. 10.Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  11. 11.Department of Laboratory MedicineUniversity of CaliforniaSan FranciscoUSA
  12. 12.Department of Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  13. 13.Phillip T. and Susan M. Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of TechnologyHarvard UniversityCharlestownUSA
  14. 14.Mental Health DepartmentMGH Revere HealthCare CenterRevereUSA

Personalised recommendations