Abstract
BackgroundIn 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period.MethodsData was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use.ResultsThere were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008–2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003–2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated.ConclusionsThere were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6882-14-504) contains supplementary material, which is available to authorized users.
Highlights
In 2011 there were 5.5 million Human immunodeficiency virus (HIV) infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it
There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB
First use of traditional healthcare (TH) was significantly higher for those dying of HIV/AIDS and TB than for those dying of other causes in 2006–2008 but not in 2009-2011(Figure 2 & Additional file 2: Table S3).The level of reported dual use of biomedical treatment and TH was significantly higher for those dying of HIV/ AIDS and TB than for those dying of other causes in each time period
Summary
In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. Traditional Medical Practitioners (TMPs) are an important component of the available healthcare resources in South Africa They often provide services with greater cultural acceptability and geographical accessibility than their biomedical counterparts [1]. In the treatment of HIV-related conditions, the holistic emphasis of the care provided by TMPs addressing psychosocial and physical aspects of disease has the potential to complement biomedical treatments and has led to efforts to integrate them with biomedical practitioners in the diagnosis and treatment of those with HIV [1,4,5] They have been reported to have an important role to play in palliative care for those with HIV/AIDS [6,7]. Notable successes in linking traditional healers with those in other health sectors have been reported from projects in Tanzania, Uganda, Zambia, Malawi and other sub-Saharan African countries , there have been a lack of systematic evaluations of these interventions [5]
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