The Risk of HIV Acquisition among Traditional Healers in South Africa: Implementing Novel Strategies to improve protective Behaviors

南非传统治疗师感染艾滋病毒的风险：实施新策略以改善保护行为

• 批准号: 9922456
• 负责人: Carolyn Audet
• 金额: $ 19.14万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922456
• 关键词: AIDS prevention; Adopted; Africa; Africa South of the Sahara; Blood; Blood-Borne Pathogens; Body Fluids; Child; Chronic Disease; Clinical; Communities; Coupled; Development; Education; Enrollment; Equipment; Evidence based practice; Exploratory/Developmental Grant; Exposure to; Feedback; Focus Groups; Frequencies; General Population; Guidelines; HIV; HIV Infections; HIV Seropositivity; Hand; Health Personnel; Health Sciences; Health Services; Health care facility; Health system; Hepatitis B Virus; Hepatitis C virus; Herb; Infection prevention; Injections; Intervention; Lead; Lesion; Medical Care Team; Modeling; Motivation; National Institute of Allergy and Infectious Disease; Occupational; Occupational Health; Participant; Patients; Population; Prevalence; Procedures; Provider; Recommendation; Reporting; Research; Research Personnel; Risk; Risk Assessment; Rural; Self Assessment; Self Efficacy; Series; Sexual Partners; Skin; South Africa; South African; Surgical incisions; Surveys; Testing; Time; Tissues; Touch sensation; Training; Training Programs; Treatment Efficacy; United States Occupational Safety and Health Administration; Virus; Visit; World Health Organization; arm; base; career; compare effectiveness; disease transmission; dissemination research; equipment training; evidence base; experience; healing; high risk; high risk population; implementation research; implementation science; implementation strategy; improved; literacy; member; novel; novel strategies; outreach; prevent; protective behavior; research to practice; seroconversion; skills; subcutaneous; success

Project Summary: In South Africa there are an estimated 200,000 traditional healers providing health services. Like allopathic health care workers (HCW), traditional healers are exposed to bloodborne pathogens through the widespread practice of traditional “injections”, where healers perform dozens of subcutaneous incisions to rub herbs directly into the bloodied skin. Ninety-eight percent of healers perform these treatments; they experience an average of 1,500 blood exposures over the course of their lifetime. This high frequency of blood exposure, coupled with treating high risk patients, can result in increased risk of patient-to-healer disease transmission if personal protective equipment (PPE) are not used. Healers in South Africa who reported patient blood touched their skin had 2.59 times higher risk of being HIV-positive than those with no exposure (59% vs. 25%); overall healers have a substantially higher HIV prevalence (30%) than the general population (19%). Free PPE are made available at local health facilities, but most healers have low levels of literacy, limited ability to assess blood exposure risk, and have no PPE training. Given these limitations, use of PPE during treatments is inconsistent. A small proportion of healers employ PPE appropriately during each treatment; these “early adopter” healers suggest PPE use is sustainable in rural sub-Saharan Africa if a healer has the necessary skills, risk assessment training, and encouragement. Our proposal compares two implementation strategies to increase PPE use during procedures and decrease the number of injections performed: (1) HCW led education on risk of blood exposure and development of PPE donning, use and doffing skills though a week- long training followed by 3 educational outreach visits at the healer's place of practice vs. (2) “Early adopter” healer and HCW co-led week-long training followed by 3 educational outreach visits. We hypothesize that the strategy of engaging “early adopter” healers as trainers will lead to more accurate participant risk assessments, increase participant self-efficacy, and lead to more consistent use of PPE during treatments. The Specific Aims of this study are to: (1) Adapt PPE training using the ADAPT-ITT model; (2) Compare fidelity of PPE training between the HCW-only team versus the healer + HCW team; (3) Compare the effects of our two implementation strategies on healer exposure to patient blood. This potentially high-impact intervention is well-suited to the R21 mechanism. While some allopathic providers may recommend an outright ban on the procedure, patients and healers have strongly believed in the efficacy of these treatments for hundreds of years- they are not likely to stop at our recommendation. It is up us to overcome our own biases to develop an effective strategy to prevent HIV seroconversion. Our team of South African and U.S. investigators has a proven record of HIV research success and specific experience successfully engaging traditional healers, HIV prevention studies, as well as, dissemination and implementation research.

项目概要：在南非，估计有 200,000 名传统治疗师提供医疗服务。 与对抗疗法医护人员 (HCW) 一样，传统治疗师也通过以下方式接触血源性病原体： 传统“注射”的广泛使用，治疗师进行数十个皮下切口进行摩擦 草药直接进入血迹斑斑的皮肤。百分之九十八的治疗师会进行这些治疗；他们经历 一生中平均接触血液 1,500 次。这种高频率的血液暴露， 再加上治疗高风险患者，如果发生以下情况，可能会导致患者到治疗者疾病传播的风险增加 不使用个人防护装备 (PPE)。南非的治疗师报告了病人的血液 接触过皮肤的人感染艾滋病病毒的风险是没有接触过的人的 2.59 倍（59% vs. 25%）；整体治疗师的艾滋病毒感染率 (30%) 远高于普通人群 (19%)。 当地卫生机构提供免费个人防护装备，但大多数治疗师识字率低、能力有限 评估血液暴露风险，并且没有接受过个人防护装备培训。鉴于这些限制，在治疗期间使用个人防护装备 不一致。一小部分治疗师在每次治疗期间适当地使用个人防护装备；这些 “早期采用者”治疗师表示，如果治疗师具备以下能力，那么在撒哈拉以南非洲农村地区，个人防护装备的使用是可持续的 必要的技能、风险评估培训和鼓励。 Our proposal compares two implementation 增加手术期间个人防护装备使用并减少注射次数的策略：(1) 医护人员 通过一周的时间，开展有关血液接触风险的教育以及个人防护装备穿戴、使用和脱下技能的培养 长期培训，然后在治疗师的执业地点进行 3 次教育外展访问与 (2)“早期采用者” 治疗师和医护人员共同领导了为期一周的培训，随后进行了 3 次教育外展访问。我们假设 让“早期采用者”治疗师担任培训师的策略将导致更准确的参与者风险评估， 提高参与者的自我效能，并导致在治疗期间更一致地使用个人防护装备。 本研究的具体目标是： (1) 使用 ADAPT-ITT 模型调整 PPE 培训； (2) 比较仅 HCW 团队与治疗师 + HCW 团队之间 PPE 培训的保真度； (3) 比较我们的两种实施策略对治疗者接触患者血液的影响。 这种潜在的高影响力干预措施非常适合 R21 机制。虽然一些对抗疗法提供者 可能会建议彻底禁止该手术，患者和治疗师都坚信其疗效 这些治疗方法已有数百年历史——它们不可能因我们的建议而停止。这取决于我们 克服我们自己的偏见，制定有效的策略来预防艾滋病毒血清转化。我们南方团队 非洲和美国研究人员拥有艾滋病毒研究成功的良好记录和成功的具体经验 让传统治疗师参与艾滋病毒预防研究以及传播和实施研究。