Can Traditional Health Practitioners Deliver HIV Counseling and Testing Services? A Pilot Study in Rural South Africa

In 2021, 7.2 million South Africans were living with HIV. Uptake of HIV testing is undermined by a combination of factors, including HIV stigma, distrust in the health system, skepticism toward allopathic medicine, preference for traditional medicine, and long distances to the nearest health facility.

We conducted a single arm pilot trial to determine the acceptability and feasibility of training traditional healers to conduct rapid HIV counseling and testing in rural South Africa. Seventeen healers were enrolled in a nationally recognized training program with the goal of healers recruiting their clients for testing during regular clinical visits.

Sixteen healers completed training and began offering HIV counseling and testing services; 14 healers enrolled participants of which 4 healers accounted for 73% of enrolled (tested) participants. Healers offered testing to 575 clients; 64 (11.1%) self-reported that they were HIV+ so were not eligible to participate and 93 refused. Healers conducted 418 HIV tests (82% uptake) with 20 (4.8%) testing HIV positive. The median age of clients was 30 years (IQR: 23-40) and 51.1% were women. In total, 34.4% had never completed an HIV test, with significantly more men reported never having tested than women.

Traditional healers in rural South Africa successfully completed a rapid, point-of-care HIV counseling and testing training. The clients of trained healers were largely willing to be tested; referral of those with a positive result to treatment proved more difficult to implement, with only 60% of those testing positive enrolling in HIV treatment services.