Abstract
Adherence to antiretroviral medication in the treatment of HIV is critical, both to maximize efficacy and to minimize the emergence of drug resistance. The aim of this prospective study in three public hospitals in KwaZulu-Natal, South Africa, is to assess the use of Traditional Complementary and Alternative Medicine (TCAM) by HIV patients and its effect on antiretroviral (ARV) adherence 6 months after initiating ARVs. 735 (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation and 519 after six months on antiretroviral therapy (ART) Results indicate that the use of herbal therapies for HIV declined significantly from 36.6% prior to antiretroviral treatment (ART) initiation to 7.9% after being on ARVs for 6 months. Faith healing methods, including spiritual practices and prayer for HIV declined from 35.8% to 22.1% and physical/body-mind therapy (exercise and massage) declined from 5.0% to 1.9%. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 87.4%. In multivariate regression analyses, ARV non-adherence (dose, schedule and food) was associated with the use of herbal treatment, not taking micronutrients and the use of over-the-counter drugs. The use of TCAM declined after initiating ARVs. As herbal treatment for HIV was associated with reduced ARV adherence, patients' use of TCAM should be considered in ARV adherence management.
Highlights
Traditional, complementary and alternative medicine (TCAM) broadly comprises herbal remedies, spiritual practices and prayer, traditional Chinese medicines, acupuncture, acupressure, chiropractic care, massage therapy, meditation, visualization, therapeutic touch and micronutrients
TCAM has been demonstrated to be widely used by people living with HIV (PLHIV), both on and off therapy with ARVs in many different settings (e.g., Langlois-Klassen et al, 2007; Ma et al, 2008; Peltzer et al, 2008; Reid et al, 2008)
In a study in KwaZulu-Natal, South Africa, TCAM was commonly used for HIV in the past six months by study participants (317, 51.3%) and herbal therapies alone (183, 29.6%) prior to antiretroviral therapy (ART) initiation
Summary
Traditional, complementary and alternative medicine (TCAM) broadly comprises herbal remedies, spiritual practices and prayer, traditional Chinese medicines, acupuncture, acupressure, chiropractic care, massage therapy, meditation, visualization, therapeutic touch and micronutrients (vitamins, minerals, and multivitamins). TCAM has been demonstrated to be widely used by people living with HIV (PLHIV), both on and off therapy with ARVs in many different settings (e.g., Langlois-Klassen et al, 2007; Ma et al, 2008; Peltzer et al, 2008; Reid et al, 2008). The use of micronutrients (42.9%) was excluded from TCAM since mostly vitamins were provided by the health facility. Herbal therapies were mainly used for pain relief (87.1%) and spiritual practices or prayer for stress relief (77.6%) (Peltzer et al, 2008). Herbal therapies were mainly used for pain relief (87.1%) and spiritual practices or prayer for stress relief (77.6%) (Peltzer et al, 2008). Babb et al (2007) studied individuals (n=44) with moderate or advanced HIV disease attending a workplace clinic providing ART in South Africa, and found that 32% were using traditional medicines, most frequently African potato (9/14) and Aloe vera (3/14), and Malangu (2007) found among HIV-infected patients on ART (n=180) in Pretoria, South Africa, that 4.4% used African traditional medicine and 3.3% complementary and alternative medicines
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