在抗逆转录病毒治疗时代，传统治疗师对艾滋病病毒的治疗在南非农村地区依然存在：一项混合方法研究
Traditional healer treatment of HIV persists in the era of ART: a mixed methods study from rural South Africa.
作者信息
Audet Carolyn M, Ngobeni Sizzy, Wagner Ryan G
机构信息
Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN, 37203-1738, USA.
MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
出版信息
BMC Complement Altern Med. 2017 Aug 30;17(1):434. doi: 10.1186/s12906-017-1934-6.
BACKGROUND
Human immunodeficiency virus (HIV) substantially contributes to the burden of disease and health care provision in sub-Saharan Africa, where traditional healers play a major role in care, due to both their accessibility and acceptability. In rural, northeastern South Africa, people living with HIV often ping-pong between traditional healers and allopathic providers.
METHODS
We conducted 27 in-depth interviews and 133 surveys with a random sample of traditional healers living in Bushbuckridge, South Africa, where anti-retroviral therapy (ART) is publicly available, to learn: (1) healer perspectives about which HIV patients they choose to treat; (2) the type of treatment offered; (3) outcomes expected, and; (4) the cost of delivering treatment.
RESULTS
Healers were mostly female (77%), older (median: 58.0 years; interquartile range [IQR]: 50-67), with low levels of formal education (median: 3.7 years; IQR: 3.2-4.2). Thirty-nine healers (30%) reported being able to cure HIV in an adult patients whose (CD4) count was >350cells/mm. If an HIV-infected patient preferred traditional treatment, healers differentiated two categories of known HIV-infected patients, CD4+ cell counts <350 or ≥350 cells/mm. Patients with low CD4 counts were routinely referred back to the health facility. Healers who reported offering/performing a traditional cure for HIV had practiced for less time (mean = 16.9 vs. 22.8 years; p = 0.03), treated more patients (mean 8.7 vs. 4.8 per month; p = 0.03), and had lower levels of education (mean = 2.8 vs. 4.1 years; p = 0.017) when compared to healers who reported not treating HIV-infected patients. Healers charged a median of 92 USD to treat patients with HIV.
CONCLUSION
Traditional healers referred suspected HIV-infected patients to standard allopathic care, yet continued to treat HIV-infected patients with higher CD4 counts. A greater emphasis on patient education and healer engagement is warranted.
背景
在撒哈拉以南非洲地区，人类免疫缺陷病毒（HIV）极大地加重了疾病负担和医疗保健负担。在该地区，传统治疗师因其可及性和可接受性在医疗保健中发挥着重要作用。在南非东北部农村地区，HIV感染者常常在传统治疗师和对抗疗法医疗服务提供者之间来回辗转。
方法
我们对居住在南非布什巴克里奇的传统治疗师进行了随机抽样，开展了27次深入访谈和133次调查。在该地，抗逆转录病毒疗法（ART）已公开可用。我们旨在了解：（1）治疗师对于选择治疗哪些HIV患者的看法；（2）提供的治疗类型；（3）预期的治疗效果；以及（4）提供治疗的成本。
结果
治疗师大多为女性（77%），年龄较大（中位数：58.0岁；四分位间距[IQR]：50 - 67），正规教育水平较低（中位数：3.7年；IQR：3.2 - 4.2）。39名治疗师（30%）报告称能够治愈CD4细胞计数>350个细胞/mm³的成年HIV患者。如果HIV感染患者倾向于传统治疗，治疗师会将已知的HIV感染患者分为两类，即CD4⁺细胞计数<350或≥350个细胞/mm³。CD4计数低的患者通常会被转回医疗机构。与报告不治疗HIV感染患者的治疗师相比，报告提供/实施HIV传统疗法的治疗师从业时间较短（平均16.9年对22.8年；p = 0.03），每月治疗的患者更多（平均每月8.7例对4.8例；p = 0.03），且教育水平较低（平均2.8年对4.1年；p = 0.017）。治疗师治疗HIV患者的收费中位数为92美元。
结论
传统治疗师将疑似HIV感染患者转至标准的对抗疗法治疗，但仍继续治疗CD4计数较高的HIV感染患者。有必要更加重视患者教育和治疗师参与。
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