Traditional healer-initiated HIV counseling and testing in rural South Africa

项目摘要 在南非，艾滋病毒检测受到艾滋病毒污名化、对对抗疗法卫生系统的不信任、 对传统医学的偏好，以及与卫生设施的距离。南非在实现这一目标方面取得了进展 他们的90-90-90目标，但很大一部分人口不定期测试;只有33.9%的成年人， 在过去的一年里，姆普马兰加农村（我们的研究地点）接受了艾滋病毒检测。在南非， 社会经济地位（SES），男性，移民和那些不信任卫生系统的人有更高的发病率， 艾滋病毒污名，更有可能寻求传统治疗师的护理，而不太可能接受艾滋病毒检测。的 治疗师的人口统计学和社会学特征密切反映了这一人群，使他们成为理想的治疗师。 弥合医疗保健利用鸿沟。 开发一个治疗师-临床医生艾滋病毒预防协作将促进检测和预防 通过三种协同策略，在传统上避免/拒绝检测的人之间建立服务联系：（1） 治疗师发起的咨询和检测（HICT），以加强艾滋病毒检测的价值和艾滋病毒的耻辱 减少和应对策略;（2）建立一个路径，为患者导航之间的传统和对抗疗法 鼓励重复艾滋病毒检测（或治疗，如果艾滋病毒呈阳性）的制度;以及（3）改善 通过减少耻辱感培训和治疗师和提供者工作的“开放日”会议， 共同为患者提供更好地了解卫生服务的机会（并增加 患者返回）。我们建议对从一个选定的群体中寻求治疗的患者进行这种新的干预试验 训练有素的传统治疗师。我们假设，寻求传统治疗的患者会发现 测试可接受，将接受艾滋病毒检测，尽管高度的耻辱和不信任的卫生系统， 在传统治疗师的帮助下，他们将在医疗机构接受治疗。 本研究的具体目的是：（1）对来自不同领域的“非测试者”进行定性访谈 社会经济地位和人口群体了解艾滋病毒污名化、对卫生系统的不信任和艾滋病毒之间的关系 测试以创建最可接受的基于治疗者的测试模式;（2）适应成功的南非 以社区为基础的艾滋病毒预防项目，以建立一个医疗保健人员-临床医生艾滋病毒检测和预防协作机构; 及（3）试行我们的医护人员-临床医生合作计划，并评估艾滋病毒检测的接受情况以及与治疗的联系 和预防服务的参与者提供治疗师发起的咨询和测试。我们的团队拥有 有良好的记录，从事传统治疗，以改善病人的结果，进行研究，以评估和 解决对卫生系统的不信任、艾滋病毒污名化问题，并制定干预措施，增加艾滋病毒检测的接受率。

Project Summary In South Africa, HIV testing has been undermined by HIV stigma, distrust in the allopathic health system, a preference for traditional medicine, and distance to the health facility. South Africa has made progress towards their 90-90-90 goals, yet a substantial proportion of the population do not test regularly; only 33.9% of adults in rural Mpumalanga (our study site) underwent HIV testing in the past year. In South Africa, people of low socioeconomic status (SES), men, immigrants, and those who distrust the health system have higher rates of HIV stigma, are more likely to seek care from traditional healers, and are less likely to receive an HIV test. The demographic and sociological characteristics of healers closely mirror this population, making them an ideal group to bridge the health care utilization divide. Development of a Healer-Clinician HIV Prevention Collaborative will facilitate testing and preventive service linkage among those who have traditionally avoided/refused testing via three synergistic strategies: (1) Healer-Initiated Counseling and Testing (HICT) to reinforce the value of HIV testing and teach HIV stigma reduction and coping strategies; (2) Establishing a path for patients to navigate between traditional and allopathic systems to encourage repeat HIV testing (or treatment, if HIV-positive); and (3) Improving the environment at the health facility via a stigma reduction training and “open house” sessions where healers and providers work together to provide patients an opportunity to better understand health services (and increase the likelihood that patients return). We propose to pilot this novel intervention with patients seeking treatment from a select group of trained traditional healers. We hypothesize that patient's seeking traditional treatment will find the offer of testing acceptable, will uptake HIV testing despite high levels of stigma and mistrust of the health system, and will engage in treatment at the health facility after linkage by their traditional healer. The Specific Aims of this study are to: (1) Conduct qualitative interviews with “non-testers” from varied SES and demographic groups to understand the interface of HIV stigma, mistrust in the health system, and HIV testing to create the most acceptable model of healer-based testing; (2) Adapt a successful South African community-based HIV prevention project to create a Healer-Clinician HIV Testing and Prevention Collaborative; and (3) Pilot our Healer-Clinician Collaborative and assess uptake of HIV testing as well as linkage to treatment and prevention services among participants offered healer-initiated counseling and testing. Our team has a proven record of engaging traditional healers to improve patient outcomes, conducting research to evaluate and address mistrust in the health system, HIV stigma, and developing interventions to increase HIV testing uptake.