Traditional Health Practitioners-Initiated HIV Testing and Counselling: Perspectives from Health Care Workers, Healers and Clients in Rural South Africa

A considerable proportion of people living with HIV remain unaware of their HIV status. In South Africa, individuals in rural areas often receive health care from both allopathic providers and traditional health practitioners (THPs). Our team piloted a task-shifting pilot study to determine the feasibility of THP-led HIV counselling and testing. Our team conducted semi-structured, qualitative interviews with healthcare workers, THPs who completed HIV counselling and testing training, and clients who received a positive test result. Interviews focused primarily on participant opinions about, and experiences with, the intervention and their perspectives on how (and if) this partnership should be maintained. Transcripts were analyzed by two authors, employing phenomenological thematic coding using the socio-ecological model. Our team conducted 33 interviews: 12 with healthcare workers, 11 with THPs, and 10 with clients who received a positive test result. A combination of deeply rooted cultural beliefs in the value of traditional medicine and dissatisfaction with the allopathic health services led most participants to value the introduction of THP-led testing. Concerns about THPs' ability to deliver testing was raised by healthcare workers, but clients reported that THPs delivered testing with fidelity. Several participants spoke about the importance of integrating THPs into the national health system to ensure they had access to test kits and support from clinicians. Integrating THPs into the health system will require the organization of a government-led training program and the creation of an official position for trained THPs within their local clinic.