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

南非农村地区由传统治疗师发起的艾滋病毒咨询和检测

• 批准号: 10319631
• 负责人: Carolyn Audet
• 金额: $ 18.86万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10319631
• 关键词: AIDS prevention; Address; Adherence; Adult; Area; Caring; Categories; Characteristics; Clinic; Clinic Visits; Clinical Trials; Communities; Community Health Aides; Coping Skills; Counseling; Coupled; Data; Development; Diagnostic Reagent Kits; Education; Enrollment; Environment; Epidemic; Event; Fright; Funding; Future; Goals; HIV; HIV Seropositivity; Health; Health Personnel; Health Services; Health care facility; Health system; Healthcare; Human immunodeficiency virus test; Immigrant; Individual; Intervention; Interview; Letters; Link; Measures; Medicine; Modeling; Mozambique; Paper; Participant; Patient-Focused Outcomes; Patients; Persons; Population; Prevalence; Preventive service; Provider; Province; Research; Resources; Rural; Site; Socioeconomic Status; Sociology; South Africa; South African; Sports; Stigmatization; System; Testing; Traditional Medicine; Training; Trust; Uncertainty; Visit; Work; arm; base; care seeking; care systems; community clinic; death anxiety; demographics; distrust; empowered; evidence base; follow-up; healing; health belief; health care service; health care service utilization; home test; implementation science; improved; innovation; low socioeconomic status; male; marginalized population; member; men; novel; pilot test; preference; prevention service; rural South Africa; self testing; service programs; social; social culture; social stigma; socioeconomics; study population; success; testing services; testing uptake; traditional care; treatment services; uptake

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.

项目概要 在南非，艾滋病毒检测因艾滋病毒耻辱、对对抗疗法卫生系统的不信任、 对传统医学的偏好以及距医疗机构的距离。南非在这方面取得了进展 他们的 90-90-90 目标，但很大一部分人没有定期进行测试；只有 33.9% 的成年人 普马兰加省农村地区（我们的研究地点）去年接受了艾滋病毒检测。在南非，低收入人群 社会经济地位 (SES)、男性、移民和不信任卫生系统的人的患病率较高 艾滋病毒耻辱，更有可能向传统治疗师寻求护理，并且不太可能接受艾滋病毒检测。这 治疗师的人口和社会学特征密切反映了这一人群，使他们成为理想的人选 组弥合医疗保健利用鸿沟。 治疗师-临床医生艾滋病毒预防合作的发展将促进检测和预防 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) 治疗者发起的咨询和检测 (HICT) 旨在强化 HIV 检测的价值并教导 HIV 耻辱感 减少和应对策略； (2) 为患者建立传统疗法与对抗疗法之间的导航路径 鼓励重复艾滋病毒检测（或治疗，如果艾滋病毒呈阳性）的系统； (3) 改善环境 通过治疗师和服务提供者工作的减少耻辱培训和“开放日”课程来改善医疗机构 共同为患者提供更好地了解医疗服务的机会（并增加 患者返回）。我们建议在选定的群体中寻求治疗的患者中试点这种新颖的干预措施 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 尽管卫生系统受到高度耻辱和不信任，但仍将接受艾滋病毒检测，并且 在与传统治疗师联系后，将在医疗机构接受治疗。 本研究的具体目标是： (1) 对来自不同领域的“非测试者”进行定性访谈 SES 和人口群体了解艾滋病毒耻辱感、对卫生系统的不信任和艾滋病毒之间的关系 进行测试以创建最可接受的基于治疗者的测试模型； (2) 适应成功的南非人 以社区为基础的艾滋病毒预防项目，旨在创建治疗师-临床医生艾滋病毒检测和预防合作组织； (3) 试点我们的治疗师与临床医生合作并评估艾滋病毒检测的采用情况以及与治疗的联系 参与者之间的预防服务提供治疗师发起的咨询和测试。我们的团队有一个 与传统治疗师合作改善患者治疗效果、开展研究以评估和治疗的良好记录 解决对卫生系统的不信任、艾滋病毒耻辱，并制定干预措施以提高艾滋病毒检测率。