Can Traditional Health Practitioners Deliver HIV Counseling and Testing Services? A Pilot Study in Rural South Africa.

INTRODUCTION

In 2021, 7.2 million South Africans were living with HIV. Uptake of HIV testing is undermined by a combination of factors, including HIV stigma, distrust in the health system, skepticism toward allopathic medicine, preference for traditional medicine, and long distances to the nearest health facility.

METHODS

We conducted a single arm pilot trial to determine the acceptability and feasibility of training traditional healers to conduct rapid HIV counseling and testing in rural South Africa. Seventeen healers were enrolled in a nationally recognized training program with the goal of healers recruiting their clients for testing during regular clinical visits.

RESULTS

Sixteen healers completed training and began offering HIV counseling and testing services; 14 healers enrolled participants of which 4 healers accounted for 73% of enrolled (tested) participants. Healers offered testing to 575 clients; 64 (11.1%) self-reported that they were HIV+ so were not eligible to participate and 93 refused. Healers conducted 418 HIV tests (82% uptake) with 20 (4.8%) testing HIV positive. The median age of clients was 30 years (IQR: 23-40) and 51.1% were women. In total, 34.4% had never completed an HIV test, with significantly more men reported never having tested than women.

CONCLUSIONS

Traditional healers in rural South Africa successfully completed a rapid, point-of-care HIV counseling and testing training. The clients of trained healers were largely willing to be tested; referral of those with a positive result to treatment proved more difficult to implement, with only 60% of those testing positive enrolling in HIV treatment services.