Traditional healers in HIV differentiated service delivery

Despite widespread adoption of differentiated service delivery (DSD) models for HIV care in Uganda, nearly one-third of people with HIV remain virally unsuppressed, and 30-60% of those initiating antiretroviral therapy (ART) in sub-Saharan Africa are lost to follow-up. Current DSD frameworks primarily serve clinically stable clients, overlooking disengaged or unstable people with HIV who face barriers like stigma, lack of social support, and negative clinic experiences. Traditional healers, trusted and accessible community figures, may complement formal systems to enhance care engagement.

This qualitative sub-study, embedded within a cluster-randomized hybrid effectiveness-implementation trial in rural southwestern Uganda, explored traditional healer-delivered HIV support. Traditional healers in the intervention arm were trained to facilitate HIV self-testing, provide adherence counseling, and offer psychosocial support to unsuppressed people with HIV. Semi-structured interviews were conducted with 18 traditional healers, 15 people with HIV, and 5 clinicians after 9-12 months of follow-up. Median age of traditional healers is 47, people with HIV is 25, and clinicians is 34 years. Inductive thematic analysis identified perceptions and experiences related to traditional healer-delivered support and engagement with care.

Three themes emerged: traditional healers fostered re-engagement with HIV services through time, attention, and personalized care often unavailable in overburdened clinics; they provided individualized adherence support, including reminders and accompaniment; and traditional healers offered counseling that reduced stigma, facilitated disclosure, and promoted self-acceptance.

Traditional healers can extend DSD principles to disengaged people with HIV by providing culturally grounded, patient-centered support. Integrating traditional healers into HIV care frameworks may strengthen re-engagement, adherence, and viral suppression, advancing progress toward HIV epidemic control.