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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/01.qai.0000437619.23031.83
Implementation and Operational Research: Epidemiology and Prevention

Reduced Adherence to Antiretroviral Therapy Among HIV-Infected Tanzanians Seeking Cure From the Loliondo Healer

Thielman, Nathan M. MD, MPH*,†,‡; Ostermann, Jan PhD*,†; Whetten, Kathryn PhD*,†; Whetten, Rachel MPH*; Itemba, Dafrosa MSCED§; Maro, Venance MD; Pence, Brian PhD*,†,¶; Reddy, Elizabeth MD†,‡,‖; The CHAT Research Team

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Abstract

Abstract: The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo (450 km away), and their adherence to antiretrovirals (ARVs) dropped precipitously (odds ratio = 0.20, 95% confidence interval: 0.09 to 0.44, P < 0.001) after the visit. Compared with those not attending Loliondo, attendees were more likely to have been diagnosed with HIV more remotely (3.8 vs. 3.0 years before, P < 0.001), have taken ARVs longer (3.4 vs. 2.5 years, P < 0.001), have higher median CD4+ lymphocyte counts (429 vs. 354 cells/mm3, P < 0.001), be wealthier (wealth index: 10.9 vs. 8.8, P = 0.034), and receive care at the private versus the public hospital (P = 0.012). In multivariable logistic regression, only years since the start of ARVs remained significant (odds ratio = 1.49, 95% confidence interval: 1.23 to 1.80). Treatment fatigue may play a role in the lure of alternative healers.

© 2014 by Lippincott Williams & Wilkins

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