Use of traditional medicine interfering with ART adherence

HIV-positive Ugandans are twice as likely to quit antiretroviral therapy (ART) if they also use traditional herbal medicine, a new study by scientists at the country's leading university has found.

Dr Ronald Kiguba, team leader of the Makerere University-led study told PlusNews the findings show that the integration of traditional healers into modern medical practice needs to be handled more cautiously.

"The World Health Organization [WHO] has reported that between 60 and 70 percent of Africans approach traditional healers as their first line of health care," he said. "At the moment, people are starting with traditional healers and then moving back and forth."

He advised that rather than shunning traditional healers, the solution was to work closely with them. "If these healers can be trained properly in HIV care then they can be a new avenue for clinical care," Kiguba commented. "It's not easy...[but] the alternative is we continue to lose patients."

The Ugandan government acknowledges the widespread use of traditional medicine and the influence of healers in the community. In conjunction with a local NGO, Traditional and Modern Health Practitioners Together against AIDS, it is integrating traditional healers into national HIV programmes.

The study, jointly conducted by Makerere University's medical school and the Joint Clinical Research Centre, looked into the reasons for discontinuation and misuse of life-prolonging ART.

It found that one in five patients sampled interrupted their therapy and one in four changed at least one component of their drug programme, risking reduced effectiveness of drug treatment.

Some Constraints to Adherence in Uganda • Level of education • Financial constraints Social support • Type of drug regimen, number of pills involved • Effects of drugs on eating patterns • Physical state and disease stage • Depression and severe anxiety • Beliefs and knowledge • Supply of drugs From Access to adherence: the challenges of antiretroviral treatment (2006)

The researchers, who presented their findings at the 14th Conference on Retroviruses and Opportunistic Infections (CROI) in Los Angeles, United States, in February, studied 686 patients at two large ART centres in the capital, Kampala.

They found that cost was the most significant factor in the discontinuation of ART, followed by negative side-effects and poor supply. Use of a traditional medical healers made patients twice as likely to give up on the drugs, which can add years to a patient's life.

Of those who discontinued, four in 10 cited the high cost of the drugs as their reason for terminating the treatment. Slightly more than 20 percent said they had stopped to avoid side-effects. Others quit because they were tired, felt depressed, felt better or were away from home.

Negative side-effects were the most significant reason given for those changing their treatment, cited by seven out of 10 of those who modified their regimens. Unmarried people, those on therapy for more than three months, patients who stated ART in 2004 or earlier and individuals taking more than two pills per day were all more likely to have altered their therapy.

"We should be able to identify those who are more likely to interrupt their treatment and give them better support," Kiguba said.

Strict adherence to ART regimens is crucial to preventing the development of drug resistance, which reduces the effectiveness of the medication. WHO recommends a period of education and preparation aimed at maximising adherence before commencing ART. Once treatment has begun, it further advises monitoring including assessment by doctors, pill counts and the use of patient questionnaires.

Over the past two years, Uganda has significantly stepped up its ART rollout, and according to the government, has reached more than 80,000 people - between 150,000 and 200,000 Ugandans need the life-prolonging medication.

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