Traditional Healers as Adherence Partners for PLHIV in Rural Mozambique

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 DESCRIPTION (provided by applicant): This career award application seeks to foster the development of Dr. Audet's career as an independent global health researcher. With the support from an NIMH K01 award, Dr. Audet plans to develop a harmonized health system linking complementary and allopathic providers to improve HIV outcomes in countries in under- resourced countries. Dr. Audet's goals are to improve and formalize relationships between allopathic and alternative providers to improve adherence among patients with HIV disease, with a geographic focus in Mozambique. High rates of HIV infection in central Mozambique (12.5%) coupled with high rates of loss to follow up among patients (50%) have resulted in a public health crisis. Major barriers to HIV treatment adherence have been fear of disclosure/ stigma, patient misunderstanding/ not believing their diagnosis, poor perceived treatment at the health facility and patient preference for traditional medicine. Healers are ideally positioned to support patient adherence by: (1) maintaining confidentiality and/or assisting with partner disclosure; (2) explaining HIV using local languages and in local cultural context; (3) advocating for their health at clinical sites; and (4) ensuring patients do not abandon care for traditional medicines. The applicant, Dr. Carolyn Audet, an Assistant Professor at Vanderbilt University, has been in the forefront of Mozambique's attempt to engage healers in a culturally appropriate manner. Her interest in working with healers to improve patient health outcomes has led to the development of National level Ministry of Health referral forms, as healers are `task shifting' int community health agents. In collaboration with the Ministry of Health, she has field-tested referral forms and training programs, establishing that healers can effectively partner with the Ministry. She is also the PI of two grants: a CDC-funded grant to improve clinical delivery of positive prevention messages among clinicians in rural Mozambique and a ViiV Health Care grant to engage men and traditional birth attendants to improve uptake of ART among HIV infected pregnant women. Responsive to NIMH's K01 program announcement, Dr. Audet seeks `protected time' for pursuing a career as an independent scientist. She will engage in additional training in the design and implementation of health messaging interventions to address culturally entrenched beliefs and behaviors at Vanderbilt University and University of Michigan (with her co-primary Mentor Dr. Amico). Dr. Audet aims to provide on-site research leadership to current funded initiatives coupled with ongoing research training and capacity building efforts at the collaborating institutions, with whom her partnerships will focus on developing a sustainable, practical, and effective relationship between traditional healers and the health care system.