title: Reduced adherence to antiretroviral therapy among HIV-infected Tanzanians seeking cure from the Loliondo healer.
abstract: : The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo (450 km away), and their adherence to antiretrovirals (ARVs) dropped precipitously (odds ratio = 0.20, 95% confidence interval: 0.09 to 0.44, P < 0.001) after the visit. Compared with those not attending Loliondo, attendees were more likely to have been diagnosed with HIV more remotely (3.8 vs. 3.0 years before, P < 0.001), have taken ARVs longer (3.4 vs. 2.5 years, P < 0.001), have higher median CD4 lymphocyte counts (429 vs. 354 cells/mm, P < 0.001), be wealthier (wealth index: 10.9 vs. 8.8, P = 0.034), and receive care at the private versus the public hospital (P = 0.012). In multivariable logistic regression, only years since the start of ARVs remained significant (odds ratio = 1.49, 95% confidence interval: 1.23 to 1.80). Treatment fatigue may play a role in the lure of alternative healers.
authors: *Center for Health Policy and Inequalities Research; †Duke Global Health Institute, Duke University, Durham, NC; ‡Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC; §Tanzania Women's Research Foundation (TAWREF), Moshi, Tanzania; ‖Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania; and ¶Department of Community and Family Medicine, Duke University Medical Center, Durham, NC.
authors: Nathan M
authors: NM
authors: Thielman
authors: Jan
authors: J
authors: Ostermann
authors: Kathryn
authors: K
authors: Whetten
authors: Rachel
authors: R
authors: Whetten
authors: Dafrosa
authors: D
authors: Itemba
authors: Venance
authors: V
authors: Maro
authors: Brian
authors: B
authors: Pence
authors: Elizabeth
authors: E
authors: Reddy
mesh_terms: D000349:Africa; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D029221:Faith Healing / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D013636:Tanzania; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents