Virtual CROI 2021: On-site HIV testing from traditional healers raises diagnoses, links to care

In rural Uganda where as many as seven out of every 100 people live with HIV, less than 40% of people who don't know their status have had a test for the virus in the last year.

A team of researchers whose study was presented today at virtual CROI 2021 wondered if that rate would rise when the traditional healers -- who are a source of health services for some, if not all,  health services  for an estimated  80% of people in southern Africa -- could provide on-site rapid HIV testing as well as referrals to care.

After a two-day training, "important to getting everyone on the same page," Dr. Radhika Sundararajan of Weil Cornell Medicine said, 17 traditional healers -- including herbalists, spiritualists, birth attendants and bone-setters were randomized to intervention and control arms serving 250 patients each. Aside from compensation for the time spent in training, none of the traditional healers received pay for their participation in the study.

Traditional healers in the intervention arm were equipped with oral swab point-of-care rapid HIV tests and information to refer those who tested positive for the virus to care and treatment. Traditional healers in the control arm were prepared only to offer the standard of care -- information on the importance of getting tested, and the nearest clinic offering tests. Researchers gathered data on the numbers of people visiting either arm getting tested for HIV in the next 90 days, as well as on the numbers diagnosed with HIV and getting into care.

The difference was dramatic, with all 250  patients who visited traditional healers in the intervention arm getting tested for HIV within the 90 days that followed, as opposed to just 57 of the 250 patients who visited traditional healers who did not have the test at hand. While 10 of the patients visiting healers equipped with the tests were diagnosed with HIV, none in the control arm were. Seven of those diagnosed reported being in care within the 90 days that followed.

With a significant increase in testing, diagnoses and care linkage, HIV testing by traditional healers holds promise, the researchers concluded.

All healers approached to participate in the study were interested in the opportunity to add to their capacities to provide services, Dr. Sundararajan said.