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

项目摘要 在南非，艾滋病毒检测因艾滋病毒污名、对对抗疗法卫生系统的不信任、 对传统医学的偏爱，以及到医疗机构的距离。南非在以下方面取得了进展 他们的90-90-90目标，但相当大一部分人口不定期测试；只有33.9%的成年人在 姆普马兰加农村(我们的研究地点)在过去的一年里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、移民和那些不信任卫生系统的人有更高的 艾滋病患者更有可能寻求传统治疗师的治疗，也不太可能接受艾滋病毒检测。这个 医疗师的人口统计和社会学特征与这一群体密切相关，这使他们成为理想群体。 小组以弥合卫生保健利用的鸿沟。 开发医生-临床医生艾滋病毒预防协作组将促进检测和预防 通过三种协同策略在那些传统上避免/拒绝测试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并教导艾滋病毒污名 减少和应对策略；(2)为患者在传统和对抗之间建立一条路径 鼓励重复进行艾滋病毒检测(如果艾滋病毒呈阳性，则进行治疗)的制度；以及(3)改善 医疗机构通过减少耻辱的培训和治疗师和提供者工作的“开放参观”会议 共同为患者提供更好地了解医疗服务的机会(并增加 病人回来了)。我们建议在从特定人群中寻求治疗的患者中试行这一新型干预 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 检测可以接受，是否会接受艾滋病毒检测，尽管对卫生系统存在很高的耻辱和不信任，以及 在他们的传统治疗师联系起来后，将在卫生设施进行治疗。 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 社会经济和人口群体了解艾滋病毒污名、对卫生系统的不信任和艾滋病毒之间的联系 测试以创建最可接受的基于治疗师的测试模型；(2)采用一个成功的南非人 以社区为基础的艾滋病毒预防项目，创建医生-临床医生艾滋病毒检测和预防协作组； 以及(3)试点我们的医疗-临床医生协作，评估艾滋病毒检测的接受情况以及与治疗的联系 参与者中的预防服务提供由治疗师发起的咨询和测试。我们队有一支 聘用传统治疗师以改善患者预后、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，并制定干预措施，以增加艾滋病毒检测的接受度。

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.