“It is better to die”: experiences of traditional health practitioners within the HIV treatment as prevention trial communities in rural South Africa (ANRS 12249 TasP trial)

ABSTRACT

The ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomized trial in rural South Africa uses a “test and treat” approach. Home-based testing services and antiretroviral treatment initiation satellite clinics were implemented in every cluster as part of the trial. A social science research agenda was nested within TasP with the aim of understanding the social, economic and contextual factors that affect individuals, households, communities and health systems with respect to TasP. Considering the rural nature of the trial setting, we sought to understand community perceptions and experiences of the TasP Trial interventions as seen through the eyes of traditional health practitioners (THPs). A qualitative study design was adopted using four repeat focus group discussions conducted with nine THPs, combined with community walks and photo-voice techniques, over a period of 18 months. A descriptive, interpretive and explanatory approach to analysis was adopted. Findings indicate that THPs engaged with the home-based testing services and HIV clinics established for TasP. Specifically, home-based testing services were perceived as relatively successful in increasing access to HIV testing. A major gap observed by THPs was linkage to HIV clinics. Most of their clients, and some of the THPs themselves, found it difficult to use HIV clinics due to fear of labelling, stigma and discrimination, and the ensuing personal implications of unsolicited disclosure. On the one hand, a growing number of patients diagnosed with HIV have found sanctuary with THPs as alternatives to clinics. On the other hand, THPs in turn have been struggling to channel patients suspected of HIV into clinics through referrals. Therefore, acceptability of the TasP test and treat approach by THPs is a major boost to the intervention, but further success can be achieved through strengthened ties with communities to combat stigma and effectively link patients into HIV care, including partnerships with THPs themselves.

KEYWORDS:

• HIV testing
• antiretroviral treatment
• treatment-as-prevention
• traditional healers
• HIV stigma
• South Africa

Acknowledgements

The authors wish to thank the Department of Health of South Africa for their support of this study, the community of Hlabisa sub-district for hosting our research and all participants who contributed to the study.

Disclosure statement

C.I. has received honoraria for services rendered to Gilead Sciences. No other potential conflict of interest was reported by the authors.

ORCID details

Mosa Moshabela http://orcid.org/0000-0002-9438-7095

Additional information

Funding

The French National Agency for Aids and Viral Hepatitis Research (ANRS) is the sponsor and co-funder of the trial. Research discussed in this publication has been co-funded by the International Initiative for Impact Evaluation, Inc. (3ie) with support from the Bill & Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessary represent the official views of 3ie or the Bill & Melinda Gates Foundation. The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) has co-funded the trial. The trial is conducted with the support of Merck & Co. Inc and Gilead Sciences that provided the Atripla® drug supply. The Africa Centre for Population Health receives core funding from the Wellcome Trust, which provides the platform for the population- and clinic-based research at the Centre.