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Traditional healers, HIV outcomes, and mortality among people living with HIV in Senegal, West Africa

Benzekri, Noelle A.a; Sambou, Jacques F.b; Ndong, Sanouc; Tamba, Ibrahima T.d; Faye, Dominiqueb; Diallo, Mouhamadou B.c; Diatta, Jean P.b; Faye, Khadimc; Sall, Ibrahimab; Sall, Fatimac; Malomar, Jean J.b; Hawes, Stephen E.e,f; Seydi, Moussac; Gottlieb, Geoffrey S.a,f on behalf of the UW-Senegal Research Collaboration

doi: 10.1097/QAD.0000000000002232
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Objectives: The goals of this study were to determine the frequency of traditional healer use among people living with HIV in Senegal, to identify predictors of traditional healer use, and to determine if traditional healer use is associated with HIV outcomes.

Design: Prospective longitudinal study.

Methods: Participants were enrolled from April 2017 to 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 traditional healer use and to determine the associations between HIV-outcomes and use of a traditional healer. Survival analysis was conducted using the Kaplan–Meier method.

Results: Data from 157 HIV-positive individuals were included; 34% reported seeking care from a traditional healer. Median follow-up was 224 days (interquartile range 118–339.5). Predictors of traditional healer use included age greater than or equal to 35 years and residence in the Casamance region. HIV-1-infected participants who sought care from a traditional healer had lower baseline CD4+ cell counts compared with 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 a traditional healer died (13.2 versus 2.9%; P = 0.03). HIV-1-infected individuals with advanced disease [odds ratio (OR) 3.58, 95% confidence interval (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 a traditional healer.

Conclusion: Traditional healer use is common among people living with HIV in Senegal and is associated with advanced disease and increased mortality. Partnering with traditional healers may be an effective strategy to improve the HIV care cascade and decrease mortality in the region.

aDepartment of Medicine, Division of Allergy and Infectious Diseases University of Washington, Seattle, Washington, USA

bCentre de Santé de Ziguinchor, Ziguinchor

cServices des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar

dCentre de Santé de Bignona, Bignona, Senegal

eDepartment of Epidemiology

fDepartment of Global Health, University of Washington, Seattle, Washington, USA.

Correspondence to Noelle A. Benzekri, Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Box 358061, 750 Republican St., Seattle, WA 98109-4725, USA. Tel: +00 1 206 543 9842; e-mail: benzekri@uw.edu

Received 13 August, 2018

Revised 26 January, 2019

Accepted 31 January, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).

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