Wanyama Jane N, Tsui Sharon, Kwok Cynthia, Wanyenze Rhoda K, Denison Julie A, Koole Olivier, van Praag Eric, Castelnuovo Barbara, Wabwire-Mangen Fred, Kwesigabo Gideon P, Colebunders Robert
1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA.
Int J STD AIDS. 2017 Sep;28(10):1018-1027. doi: 10.1177/0956462416685890. Epub 2017 Feb 5.
Traditional healers provide healthcare to a substantial proportion of people living with HIV infection (PLHIV) in high HIV burden countries in sub-Saharan Africa. However, the impact on the health of retained patients visiting traditional healers is unknown. In 2011, a study to asses adherence to anti-retroviral therapy (ART) performed in 18 purposefully selected HIV treatment centers in Tanzania, Zambia and Uganda showed that 'consulting a traditional healer/herbalist because of HIV' was an independent risk factor for incomplete ART adherence. To identify characteristics of PLHIV on ART who were also consulting traditional healers, we conducted a secondary analysis of the data from this study. It was found that 260 (5.8%) of the 4451 patients enrolled in the study had consulted a traditional healer during the last three months because of HIV. In multivariable analysis, patients with fewer HIV symptoms, those who had been on ART for >5.3 years and those from Tanzania were more likely to have consulted a traditional healer. However, at the time of the study, there was a famous healer in Manyara district, Loliondo village of Tanzania who claimed his herbal remedy was able to cure all chronic diseases including HIV. HIV treatment programs should be aware that patients with fewer HIV symptoms, those who have been on ART for five or more years, and patients attending ART centers near famous traditional healers are likely to consult traditional healers. Such patients may need more support or counseling about the risks of both stopping ART and poor adherence. Considering the realities of inadequate human resources for health and the burden of disease caused by HIV in sub-Saharan Africa, facilitating a collaboration between allopathic and traditional health practitioners is recommended.
在撒哈拉以南非洲艾滋病毒负担较重的国家,传统治疗师为很大一部分感染艾滋病毒的人(PLHIV)提供医疗服务。然而,传统治疗师对复诊患者健康状况的影响尚不清楚。2011年,在坦桑尼亚、赞比亚和乌干达的18个经过特意挑选的艾滋病毒治疗中心进行的一项评估抗逆转录病毒疗法(ART)依从性的研究表明,“因感染艾滋病毒而咨询传统治疗师/草药医生”是抗逆转录病毒疗法依从性不完全的一个独立风险因素。为了确定同时咨询传统治疗师的接受抗逆转录病毒治疗的艾滋病毒感染者的特征,我们对该研究的数据进行了二次分析。结果发现,在该研究纳入的4451名患者中,有260名(5.8%)在过去三个月内因感染艾滋病毒而咨询过传统治疗师。在多变量分析中,艾滋病毒症状较少的患者、接受抗逆转录病毒治疗超过5.3年的患者以及来自坦桑尼亚的患者更有可能咨询过传统治疗师。然而,在研究期间,坦桑尼亚曼亚拉区洛利翁多村有一位著名的治疗师,他声称自己的草药疗法能够治愈包括艾滋病毒在内的所有慢性病。艾滋病毒治疗项目应意识到,艾滋病毒症状较少的患者、接受抗逆转录病毒治疗五年或更长时间的患者以及在著名传统治疗师附近的抗逆转录病毒治疗中心就诊的患者可能会咨询传统治疗师。这类患者可能需要更多关于停止抗逆转录病毒治疗和依从性差的风险的支持或咨询。考虑到撒哈拉以南非洲卫生人力资源不足以及艾滋病毒所致疾病负担的现实情况,建议促进对抗疗法和传统保健从业者之间的合作。
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