Traditional healers, hiv outcomes, and mortality among people living with hiv in senegal, west africa.

OBJECTIVES: The goals of this study were to determine the frequency of traditional healer (TH) use among PLHIV in Senegal, to identify predictors of TH use, and to determine if TH use is associated with HIV outcomes.

DESIGN: Prospective longitudinal study METHODS:: Subjects were enrolled from April 2017-April 2018 in Dakar and Ziguinchor, Senegal. Interviews, clinical evaluations, laboratory analyses, and chart review were conducted. Logistic regression was used to identify sociodemographic predictors of TH use and to determine the associations between HIV-outcomes and use of TH. Survival analysis was conducted using the Kaplan-Meier method.

RESULTS: Data from 157 HIV-positive individuals were included; 34% reported seeking care from TH. Median follow-up was 224 days (IQR 118-339.5). Predictors of TH use included age ≥35 and residence in the Casamance Region. HIV-1 infected subjects who sought care from TH had lower baseline CD4 counts compared to those who did not (104 versus 208; p = 0.02), and a greater percentage presented with advanced disease (85% versus 62%; p = 0.01). A greater percentage of those who sought care from TH died (13.2% versus 2.9%; p = 0.03). HIV-1 infected individuals with advanced disease (OR 3.58, 95%CI 1.18-10.82), those who were malnourished (OR 3.79, 95%CI 1.63-8.83), and those who died during follow-up (OR 7.26, 95%CI 1.34-39.37) were more likely to have sought care from TH.

CONCLUSION: TH use is common among PLHIV in Senegal and is associated with advanced disease and increased mortality. Partnering with TH may be an effective strategy to improve the HIV care cascade and decrease mortality in the region.