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The overall goal of this project is to adapt and assess the impact of a traditional healer training program/intervention on the adherence, retention, and viral load of HIV infected patients newly initiated on anti-retroviral therapy (ART) in rural Mozambique.
Incorporating healers as anti-retroviral therapy (ART) adherence counselors can help reduce the crisis of HIV treatment abandonment. Healers are often accused of encouraging patients to abandon HIV care, but they can also serve as strong advocates for patient health. When healers were engaged as tuberculosis (TB) adherence counselors in South Africa, their patients were as successful as those supported by non-healer counselors. An innovative solution would be to engage trained healers as treatment partners to support medication and appointment adherence for PLHIV.
Healers are well positioned to address reported patient concerns, including: (1) keeping a patients HIV status a secret while providing support; (2) assisting with partner disclosure and initiating community/clinical systems of assistance if gender base violence is threatened/occurs; and (3) advocating for patients during clinical visits to ensure quality care is provided. Other programs in SSA have shown that incorporating healers into an allopathic health system as adherence supporters for TB treatment is feasible, but healer use in HIV treatment is not well-documented. This novel intervention would provide patients newly initiated on ART a choice to nominate a specially trained healer as a treatment partner, and assess acceptability, feasibility, and patient outcomes using an interrupted time series quasi-experimental design. Community-based treatment partners can improve pharmacy adherence and loss to follow up (LTFU), while decreasing stigma and isolation.
Engaging healers to conduct counseling sessions in a community setting to improve ART adherence necessitates technical clinical and psychosocial training. The ART Adherence Support Worker Training program (from FHI 360) will be adapted (using ADAPT-ITT) and used to train healers to be quality treatment partners and advocates. The training will ensure healers have the knowledge and skills to effectively: (1) Educate PLHIV about ART and HIV care; (2) Assess serious ART side effects or HIV co-infections; (3) Counsel patients about safer strategies for partner disclosure (with assistance if needed); (4) Accompany the patient for each clinical appointment; and (5) Advocate for quality health care delivery when assisting each patient. The FGH training team will conduct training of the healers. All patients initiating ART will be screened for interest in having a healer treatment partner. Control and intervention patients will be followed for one year, allowing us to compare outcomes at 12-months to study the effectiveness of healers as adherence partners.
Traditional Healer Support Program, Standard of Care
Namacurra Sede Health Facility
Vanderbilt University Medical Center
Published on BioPortfolio: 2017-03-12T18:53:35-0400
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