title: Changing use of traditional healthcare amongst those dying of HIV related disease and TB in rural South Africa from 2003 - 2011: a retrospective cohort study.
abstract: BACKGROUND
  In 2011 there were 5.5 million HIV infected people in South Africa and 71% of those requiring antiretroviral therapy (ART) received it. The effective integration of traditional medical practitioners and biomedical providers in HIV prevention and care has been demonstrated. However concerns remain that the use of traditional treatments for HIV-related disease may lead to pharmacokinetic interactions between herbal remedies and ART drugs and delay ART initiation. Here we analyse the changing prevalence and determinants of traditional healthcare use amongst those dying of HIV-related disease, pulmonary tuberculosis and other causes in a rural South African community between 2003 and 2011. ART was made available in this area in the latter part of this period.
  
  
  METHODS
  Data was collected during household visits and verbal autopsy interviews. InterVA-4 was used to assign causes of death. Spatial analyses of the distribution of traditional healthcare use were performed. Logistic regression models were developed to test associations of determinants with traditional healthcare use.
  
  
  RESULTS
  There were 5929 deaths in the study population of which 47.7% were caused by HIV-related disease or pulmonary tuberculosis (HIV/AIDS and TB). Traditional healthcare use declined for all deaths, with higher levels throughout for those dying of HIV/AIDS and TB than for those dying of other causes. In 2003-2005, sole use of biomedical treatment was reported for 18.2% of HIV/AIDS and TB deaths and 27.2% of other deaths, by 2008-2011 the figures were 49.9% and 45.3% respectively. In bivariate analyses, higher traditional healthcare use was associated with Mozambican origin, lower education levels, death in 2003-2005 compared to the later time periods, longer illness duration and moderate increases in prior household mortality. In the multivariate model only country of origin, time period and illness duration remained associated.
  
  
  CONCLUSIONS
  There were large decreases in reported traditional healthcare use and increases in the sole use of biomedical treatment amongst those dying of HIV/AIDS and TB. No associations between socio-economic position, age or gender and the likelihood of traditional healthcare use were seen. Further qualitative and quantitative studies are needed to assess whether these figures reflect trends in healthcare use amongst the entire population and the reasons for the temporal changes identified.
authors.affiliation: Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. paul.mee@wits.ac.za.
authors.forename: Paul
authors.initials: P
authors.lastname: Mee
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Wagner
authors.forename: Francesc Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.forename: Chodziwadziwa
authors.initials: C
authors.lastname: Kabudula
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Madhavan
authors.forename: Mark
authors.initials: M
authors.lastname: Collinson
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Tollman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000401:mortality / Q000628:therapy*; D055815:Young Adult