Study that empowers traditional health practitioners to test for HIV expands in rural SA

21 May 2024 - Wits University

National Institutes of Health 5-year, $2.8m grant to Wits and Vanderbilt University will advance traditional health practitioner-initiated HIV testing.

The grant enables building on the success of a study completed last year, where traditional health practitioners (THPs) were trained to initiate HIV counselling, testing, and linkage to care in Bushbuckridge, Mpumalanga.

The expanded study, known as Know Your Status, is located at the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), a research unit in Bushbuckridge, Mpumalanga under the auspices of the Wits School of Public Health, in partnership with the Vanderbilt Institute for Global Health (VIGH) in the U.S.

Dr Ryan Wagner, Senior Research Fellow at Agincourt and Co-Principal Investigator, with Carolyn Audet, Associate Professor of Health Policy, and VIGH Principal Investigator, lead the study.

The study will compare rates of HIV testing in THP-initiated HIV counselling and testing communities versus control communities in a cluster randomized controlled trial in 42 clinical catchment areas.

THPs will advertise and offer free testing to their clients and clients’ partners, and take part in monthly local, community-based testing outreach activities at local events.

In addition to offering testing, THPs will further support their clients who test positive by accompanying them to the Department of Health (DoH) clinics for counselling and antiretroviral therapy (ART), and ensure that their clients regularly take their ART.

The need for HIV diagnosis

While South Africa has made progress in reaching the United Nations’ 95-95-95 targets (95% of people living with HIV knowing their status, 95% of people receiving care after diagnosis, and 95% of people achieving viral load suppression while being treated), people of low socioeconomic status, males, and those in rural areas do not test regularly.

However, these groups are more likely to seek care from THPs, which makes THPs ideal for enabling diagnosis and aftercare, if required.

Know Your Status – towards ending HIV transmission

This expanded research project is a collaboration between Wits’ Agincourt, Vanderbilt, the South African Department of Health (DoH), and Kukula, the local traditional health practitioners’ organisation.

It is part of Ntirhisano (meaning ‘working together’ in the local xiTsonga language), a larger portfolio of work that explores ways of engaging THPs to strengthen the primary health care system.

The Know Your Status study seeks to evaluate the effectiveness, incremental costs, and results of the intervention and control sites, including clinical and economic outcomes, with the goal of providing evidence to the DoH for longer term sustainability and uptake.

Wagner says, “The Know Your Status is an extremely innovative and important study, which offers the possibility of targeting HIV counselling, testing and ART to those who don’t regularly access clinics. Targeting, testing, and treating via traditional health practitioners could ultimately lead to the end of new HIV cases in communities such as rural Mpumalanga, which has some of the largest HIV burden globally.” 

Global implications of reduced HIV infection

Reflecting on wider application of the work, Audet says, “If traditional healers can be trained to conduct testing, informal community leaders in the U.S. can potentially join forces to reach those at the highest risk of HIV acquisition. Barbers, religious leaders, and teachers are examples of trusted members within communities.”

This research is funded by the National Institute of Mental Health (R01MH135738), an Institute of the U.S. National Institutes of Health. Wits University and Vanderbilt University  are Strategic Partners. Read more about the Know Your Status study and the broader Ntirhisano portfolio of work here: www.wits.ac.za/ntirhisano