14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. ThPeB7264

BACKGROUND: In the rural district of Hlabisa, South Africa, adult tuberculosis admissions increased by 360% (from 303 to 1 393) between 1991 and 1998 with 65% of TB patients being co-infected with HIV by 1997. The prevalence of HIV among pregnant women in Hlabisa in 1999 was 32.5%. The purpose of this study was to assess the acceptability and effectiveness of traditional healers as supervisors of TB treatment in an existing TB-DOTS programme.

METHODS: An observational study comparing treatment outcomes among new TB patients in 3 intervention sub-districts offered the additional option of traditional healers for DOT supervision, with those in the remainder of the district offered the standard range of options for DOT supervision (health facility, community health worker and lay persons). A comparison was also made of treatment outcomes between different options for DOT supervision.

RESULTS: When comparing the intervention area to the remainder of the district, treatment completion and mortality rates were similar but fewer patients in the study area transferred out (4%) compared with the remainder of the district (22%; p<0.0001). Comparing the different options for DOTS in the intervention sites: TB patients supported by traditional healers achieved an 89% (n = 47) treatment completion, 6% (n = 3) mortality, 6% (n = 3) default and 0% transfer rate in comparison to all other supervisors who achieved a 67% (n = 157) treatment completion, 18% (n = 41) mortality, 10% (n = 23) default and 5% (n = 12) transfer rate. The treatment completion (p=0.002) and mortality differences (p=0.04) were significantly better for traditional healers. Interviews with 41 of 51 traditional healer patients who had completed treatment, revealed high levels of satisfaction with the care received.

CONCLUSIONS: Traditional healers make an effective contribution to TB programme performance in this pilot scheme in Hlabisa district. Further evaluation will be necessary as this approach is scaled up.

Presenting author: Mark Colvin

1Medical Research Council of South Africa, Medical Research Council, PO Box 70380, Overport, 4067, South Africa.

2Hlabisa Hospital, Hlabisa, South Africa, Hlabisa, South Africa.

3Stop TB Department, World Health Organisation, Geneva, Switzerland.

4Adelaide University and University of South Australia, Adelaide, Australia.

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Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.