How informal healthcare providers improve uptake of HIV testing: qualitative results from a randomized controlled trial.

TitleHow informal healthcare providers improve uptake of HIV testing: qualitative results from a randomized controlled trial.
Publication TypeJournal Article
Year of Publication2022
AuthorsPonticiello M, Mwanga-Amumpaire J, Tushemereirwe P, Nuwagaba G, Nansera D, King R, Muyindike W, Sundararajan R
JournalAIDS
Volume36
Issue8
Pagination1161-1169
Date Published2022 Jul 01
ISSN1473-5571
KeywordsAdolescent, Adult, Counseling, Female, Health Personnel, HIV Infections, Humans, Male, Rural Population, Uganda
Abstract

OBJECTIVE: Uganda is HIV-endemic with a prevalence of 5.7%. Lack of epidemic control has been attributed to low engagement with HIV testing. Collaborating with informal healthcare providers, such as traditional healers, has been proposed as a strategy to increase testing uptake. We explored acceptability and implementation of an HIV testing program where traditional healers delivered point-of-care testing and counseling to adults of unknown serostatus (clinicaltrials.gov NCT#03718871).

METHODS: This study was conducted in rural, southwestern Uganda. We interviewed participating traditional healers ( N  = 17) and a purposive sample of trial participants ( N  = 107). Healers were practicing within 10 km of Mbarara township, and 18+ years old. Participants were 18+ years old; sexually active; had received care from participating healers; self-reported not receiving an HIV test in prior 12 months; and not previously diagnosed with HIV infection. Interviews explored perceptions of a healer-delivered HIV testing model and were analyzed following a content-analysis approach.

RESULTS: Most participants were female individuals ( N  = 68, 55%). Healer-delivered HIV testing overcame structural barriers, such as underlying poverty and rural locations that limited use, as transportation was costly and often prohibitive. Additionally, healers were located in villages and communities, which made services more accessible compared with facility-based testing. Participants also considered healers trustworthy and 'confidential'. These qualities explain some preference for healer-delivered HIV testing, in contrast to 'stigmatizing' biomedical settings.

CONCLUSION: Traditional healer-delivered HIV testing was considered more confidential and easily accessible compared with clinic-based testing. Offering services through traditional healers may improve uptake of HIV testing services in rural, medically pluralistic communities.

DOI10.1097/QAD.0000000000003227
Alternate JournalAIDS
PubMed ID35442219
PubMed Central IDPMC9262827
Grant ListK23 MH111409 / MH / NIMH NIH HHS / United States
P30 AI036214 / AI / NIAID NIH HHS / United States
UL1 TR001442 / TR / NCATS NIH HHS / United States