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Abstract：
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/mm3. If an HIV-infected patient preferred traditional treatment, healers differentiated two categories of known HIV-infected patients, CD4+ cell counts <350 or ≥350 cells/mm3. 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.
CONCLUSIONS: 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.
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/mm3. If an HIV-infected patient preferred traditional treatment, healers differentiated two categories of known HIV-infected patients, CD4+ cell counts <350 or ≥350 cells/mm3. 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.
CONCLUSIONS: 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.
摘要：
背景：人类免疫缺陷病毒（HIV）在很大程度上增加了撒哈拉以南非洲的疾病负担和医疗保健负担，传统治疗师在护理中起着重要作用，由于它们的可及性和可接受性。在农村,南非东北部,艾滋病毒感染者经常在传统治疗师和对抗疗法提供者之间打乒乓球。
方法：我们对居住在布什克里奇的传统治疗师进行了27次深入访谈和133次调查，南非,抗逆转录病毒疗法(ART)是公开的，了解：（1）治疗师对他们选择治疗的HIV患者的观点；（2）提供的治疗类型；（3）预期的结果，以及；(4)提供治疗的成本。
结果：治疗者大多是女性（77%），年龄较大（中位数：58.0岁；四分位数间距[IQR]：50-67），正规教育水平较低(中位数：3.7年；IQR：3.2-4.2)。39名治疗者（30％）报告能够治愈（CD4）计数>350个细胞/mm3的成年患者的HIV。如果感染艾滋病毒的患者更喜欢传统治疗，治疗师区分了两类已知的HIV感染患者，CD4+细胞计数<350或≥350细胞/mm3。CD4计数低的患者通常被送回医疗机构。报告提供/进行传统治疗HIV的治疗师的执业时间较短（平均=16.9vs.22.8年；p=0.03)，治疗更多患者(平均8.7vs.每月4.8；p=0.03)，教育水平较低(平均值=2.8vs.4.1年；p=0.017）与报告未治疗HIV感染患者的治疗师相比。治疗者收取治疗HIV患者的中位数为92美元。
结论：传统治疗者将疑似HIV感染患者转诊至标准的同种疗法治疗，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的参与。
方法：我们对居住在布什克里奇的传统治疗师进行了27次深入访谈和133次调查，南非,抗逆转录病毒疗法(ART)是公开的，了解：（1）治疗师对他们选择治疗的HIV患者的观点；（2）提供的治疗类型；（3）预期的结果，以及；(4)提供治疗的成本。
结果：治疗者大多是女性（77%），年龄较大（中位数：58.0岁；四分位数间距[IQR]：50-67），正规教育水平较低(中位数：3.7年；IQR：3.2-4.2)。39名治疗者（30％）报告能够治愈（CD4）计数>350个细胞/mm3的成年患者的HIV。如果感染艾滋病毒的患者更喜欢传统治疗，治疗师区分了两类已知的HIV感染患者，CD4+细胞计数<350或≥350细胞/mm3。CD4计数低的患者通常被送回医疗机构。报告提供/进行传统治疗HIV的治疗师的执业时间较短（平均=16.9vs.22.8年；p=0.03)，治疗更多患者(平均8.7vs.每月4.8；p=0.03)，教育水平较低(平均值=2.8vs.4.1年；p=0.017）与报告未治疗HIV感染患者的治疗师相比。治疗者收取治疗HIV患者的中位数为92美元。
结论：传统治疗者将疑似HIV感染患者转诊至标准的同种疗法治疗，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的参与。
