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No Association Found Between Traditional Healer Use and Delayed Antiretroviral Initiation in Rural Uganda

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Abstract

Traditional healer and/or spiritual counselor (TH/SC) use has been associated with delays in HIV testing. We examined HIV-infected individuals in southwestern Uganda to test the hypothesis that TH/SC use was also associated with lower CD4 counts at antiretroviral therapy (ART) initiation. Approximately 450 individuals initiating ART through an HIV/AIDS clinic at the Mbarara University of Science and Technology (MUST) were recruited to participate. Patients were predominantly female, ranged in age from 18 to 75, and had a median CD4 count of 130. TH/SC use was not associated with lower CD4 cell count, but age and quality-of-life physical health summary score were associated with CD4 cell count at initiation while asset index was negatively associated with CD4 count at ART initiation. These findings suggest that TH/SC use does not delay initiation of ART.

Resumen

La consulta con un curandero tradicional y/o consejero espiritual (TH/SC) ha sido asociada a retrasos para someterse a la prueba de VIH. Evaluamos personas con VIH en el sudoeste de Uganda para poner a prueba la hipótesis de que consultar con un TH/SC también está asociado a un conteo bajo de células CD4 al inicio de una terapia antirretroviral (ART). Se reclutó aproximadamente 450 personas iniciando ART en una clínica de VIH/SIDA en la Universidad de Mbarara de Ciencia y Tecnología (MUST). Los pacientes fueron predominantemente mujeres, entre las edades de 18 y 75, cuyo recuento mediano de CD4 estaba en 130. Se encontró que la consulta con un TH/SC no está asociada a un recuento menor de células CD4. Sin embargo, la edad y la calidad de vida física sí se encontraron asociados al recuento de células CD4 al inicio. En contraste, el índice-de-recurso se encontró asociado negativamente con el recuento de CD4 al inicio del ART. Estos hallazgos sugieren que la consulta con un TH/SC no resulta en un atraso para iniciar la ART.

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Acknowledgments

We would like to acknowledge Dr. Paul Bolton of Boston University for generously providing the locally validated version of the Hopkins Symptom Check list. This study received funding by the National Institutes of Health (RO1MH54907; K24MH87227; P30AI027763; UL1RR024131). Dr. Tsai acknowledges salary support through the Robert Wood Johnson Health and Society Scholars Program.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Russell H. Horwitz

  2. Harvard Medical School, Boston, MA, USA

    Russell H. Horwitz & David R. Bangsberg

  3. Robert Wood Johnson Health and Society Scholars Program, Harvard University, Cambridge, MA, USA

    Alexander C. Tsai

  4. Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda

    Samuel Maling

  5. Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda

    Francis Bajunirwe

  6. Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA

    Francis Bajunirwe

  7. Harvard Initiative for Global Health, Cambridge, MA, USA

    Jessica E. Haberer & David R. Bangsberg

  8. Center for Global Health, Massachusetts General Hospital, Boston, MA, USA

    Jessica E. Haberer & David R. Bangsberg

  9. Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda

    Nneka Emenyonu, Conrad Muzoora & David R. Bangsberg

  10. Department of Medicine, University of California, San Francisco, CA, USA

    Nneka Emenyonu & Peter W. Hunt

  11. Department of Laboratory Medicine, University of California, San Francisco, CA, USA

    Peter W. Hunt

  12. Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA

    Jeffrey N. Martin

  13. Phillip T. and Susan M. Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, Harvard University, Charlestown, MA, USA

    David R. Bangsberg

  14. Mental Health Department, MGH Revere HealthCare Center, 300 Ocean Avenue, Revere, MA, 02151, USA

    Russell H. Horwitz

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  1. Russell H. Horwitz
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  2. Alexander C. Tsai
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  6. Nneka Emenyonu
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Corresponding author

Correspondence to Russell H. Horwitz.

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Horwitz, R.H., Tsai, A.C., Maling, S. et al. No Association Found Between Traditional Healer Use and Delayed Antiretroviral Initiation in Rural Uganda. AIDS Behav 17, 260–265 (2013). https://doi.org/10.1007/s10461-011-0132-7

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  • DOI: https://doi.org/10.1007/s10461-011-0132-7

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