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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

JAIDS Journal of Acquired Immune Deficiency Syndromes: March 1st, 2014 - Volume 65 - Issue 3 - p e104–e109
doi: 10.1097/01.qai.0000437619.23031.83
Implementation and Operational Research: Epidemiology and Prevention
IOR articles

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.

*Center for Health Policy and Inequalities Research;

Duke Global Health Institute, Duke University, Durham, NC;

Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC;

§Tanzania Women's Research Foundation (TAWREF), Moshi, Tanzania;

Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania; and

Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.

Correspondence to: Nathan M. Thielman, MD, MPH, Duke Global Health Institute, Duke University, Duke Box 90519, Durham, NC 27708 (e-mail:

Study concept: N.M.T., J.O., K.W., B.P., and E.R. Data acquisition: R.W., D.I., and V.M. Analysis: J.O., N.M.T., K.W., B.P., and E.R. Drafting article: N.M.T., E.R., and J.O. Approval of final article: All the authors.

Presented in part at the 19th International AIDS Conference, July 22–27, 2012, Washington, DC. Abstract no. MOPE436.

Supported by Grant 5R01MH078756 from the National Institute of Mental Health and the Duke Center for AIDS Research, 5P30-AI064518-08. KL2 RR024127-04 provided salary support for Dr Reddy. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors have no conflicts of interest to disclose.

CHAT Research Team: Bernard Agala, Beatrice Lema, Yombya Madukwa, Restituta Mvungi, Amiri Mrema, Wendy Ricky, Ludovic Samora, and Blandina Zenze.

Received August 28, 2013

Accepted August 28, 2013

© 2014 by Lippincott Williams & Wilkins