title: "It is better to die": experiences of traditional health practitioners within the HIV treatment as prevention trial communities in rural South Africa (ANRS 12249 TasP trial).
abstract: The ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomized trial in rural South Africa uses a "test and treat" approach. Home-based testing services and antiretroviral treatment initiation satellite clinics were implemented in every cluster as part of the trial. A social science research agenda was nested within TasP with the aim of understanding the social, economic and contextual factors that affect individuals, households, communities and health systems with respect to TasP. Considering the rural nature of the trial setting, we sought to understand community perceptions and experiences of the TasP Trial interventions as seen through the eyes of traditional health practitioners (THPs). A qualitative study design was adopted using four repeat focus group discussions conducted with nine THPs, combined with community walks and photo-voice techniques, over a period of 18 months. A descriptive, interpretive and explanatory approach to analysis was adopted. Findings indicate that THPs engaged with the home-based testing services and HIV clinics established for TasP. Specifically, home-based testing services were perceived as relatively successful in increasing access to HIV testing. A major gap observed by THPs was linkage to HIV clinics. Most of their clients, and some of the THPs themselves, found it difficult to use HIV clinics due to fear of labelling, stigma and discrimination, and the ensuing personal implications of unsolicited disclosure. On the one hand, a growing number of patients diagnosed with HIV have found sanctuary with THPs as alternatives to clinics. On the other hand, THPs in turn have been struggling to channel patients suspected of HIV into clinics through referrals. Therefore, acceptability of the TasP test and treat approach by THPs is a major boost to the intervention, but further success can be achieved through strengthened ties with communities to combat stigma and effectively link patients into HIV care, including partnerships with THPs themselves.
authors.affiliation: a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa.|b School of Nursing and Public Health , University of KwaZulu-Natal , Durban , South Africa.
authors.forename: Mosa
authors.initials: M
authors.lastname: Moshabela
authors.affiliation: a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa.
authors.forename: Thembelihle
authors.initials: T
authors.lastname: Zuma
authors.affiliation: c INSERM U1219 - Centre Inserm Bordeaux Population Health , Université de Bordeaux , Bordeaux , France.|d Université de Bordeaux, ISPED , Centre INSERM U1219-Bordeaux Population Health , Bordeaux , France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Orne-Gliemann
authors.affiliation: a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa.|e Research Department of Infection and Population Health , University College London , London , UK.
authors.forename: Collins
authors.initials: C
authors.lastname: Iwuji
authors.affiliation: a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa.|f Centre Population & Développement (Ceped UMR 196 UPD IRD) , Institut de Recherche pour le Développement , Paris , France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Larmarange
authors.affiliation: a Africa Centre for Population Health , University of KwaZulu-Natal , Mtubatuba , South Africa.|e Research Department of Infection and Population Health , University College London , London , UK.|f Centre Population & Développement (Ceped UMR 196 UPD IRD) , Institut de Recherche pour le Développement , Paris , France.|g Faculty of Medicine and Faculty of Social, Human and Mathematical Sciences , University of Southampton , Southampton , UK.
authors.forename: Nuala
authors.initials: N
authors.lastname: McGrath
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D035843:Biomedical Research; D004192:Discrimination, Psychological; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D010465:Perception; D011287:Prejudice; D036301:Qualitative Research; D012107:Research Design; D012424:Rural Population; D057545:Social Stigma; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents
keywords: HIV stigma; HIV testing; South Africa; antiretroviral treatment; traditional healers; treatment-as-prevention