Our work

Work to date has largely focused on HIV, with a recent grant training healers to provide HIV counseling and testing to their clients and linkage to biomedical care for those who test positive (NIMH R34MH122259). Through this research, we were able to show that:

• Healers with minimal formal education can successfully complete a standardized HIV counselling and testing curriculum (with 94% of healers participating successfully completed both the written and practical aspects of the training)
• Individuals seeking care from traditional healers accept to be tested by trained traditional healers with 80% of individuals seeking care from traditional healers agreeing to be test.
• Through HIV testing, traditional healers are identifying previously undiagnosed people living with HIV; evidence that by training traditional healers to undertake HCT, new cases of HIV can be identified.

Future research aims to scale this research to the sub-district level and undertake a cost-effectiveness analysis to provide economic evidence of the potential impact of this intervention.

Recognising the blood exposure risk that healers face when performing traditional ‘vaccinations’, previous work has used a ‘training of trainers’ model to train healers in the use of personal protective equipment (PPE) – namely to reduce the risk of HIV acquisition (NIAID R21AI150302).

In this work, healers were provided PPE training by either 1.) a health care worker or 2.) a traditional healer who had been trained by a health care worker. This research found the traditional healers trained by other traditional healers were just as effective at using PPE as traditional healers who were trained by a health care worker.

Future work seeks to build on these findings by attempting to address several key questions including:

• In addition to blood-borne pathogens, can PPE protect traditional healers from other communicable diseases (e.g., pulmonary tuberculosis, see next section)?
• What is the appropriate mechanism and method for healers to access personal protective equipment from the government?
• What mandate, if any, does the government have to provide healers with PPE based on occupational health regulations and policies?

We look forward to continuing discussions with colleagues in Occupational Health as well as sub-district health officials as we seek to develop future grant applications that address these questions and ultimately extend and deepen this line of work.

In addition to HIV, Tuberculosis continues to significantly contribute to the burden of communicable disease in rural South Africa. Work we published earlier this year highlights the fact that specific traditional conditions (Tindzhaka and Mafulhara) have similar symptoms to pulmonary tuberculosis.

Future work aims to assess whether, in fact, these traditional illnesses are pulmonary tuberculosis or some other disease entity (e.g. pneumonia).

In discussions with colleagues who are TB doctors, there is strong and renewed interest globally in developing innovative interventions to target the identification and treatment of TB. It is anticipated that our preliminary work can support this effort.

South Africa continues to undergo an epidemiological transition marked by persisting levels of communicable disease and an increasing burden of non-communicable disease, including stroke. In recognising this burden and the potential role that traditional healer could play, together with US clinical collaborators, we have developed a grant application that seeks to collaborate with traditional healers to promote secondary stroke prevention in the rural South African setting. 

This work is currently under review and seeks to train traditional healers to counsel stroke survivors using contextually relevant information materials that will be developed as part of the research and deploy trained healers to educate stroke patients on secondary stroke prevention and medical management compliance.

In addition to the epidemiological transition described above, South Africa and notably rural South Africa, is also undergoing a demographic transition, marked by an aging population. As people age, their needs change and often include increased healthcare needs, reduced physical activity and assistance with activities of daily living. Preliminary evidence suggests that traditional healers do play some role in providing care to older, rural South Africans.

Future work seeks to better understand the current role that traditional healers play in the provision of care to older rural South African and to understand potential ways in which healers might play a larger role including assistance in drug adherence, supporting in activities of daily living and identifying and referring individuals to biomedical care (and assisting the primary health care facilities in providing step-down care).