# Know your status: A cluster randomized controlled trial comparing healer-initiated HIV counseling and testing to standard of care in rural South Africa

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2024 · $705,521

## Abstract

South Africa has made progress towards their 95-95-95 goals, yet a substantial proportion of the population
do not test regularly. In South Africa, people of low socioeconomic status, men, people in rural areas, and those
who distrust the health system have higher rates of HIV stigma and are less likely to receive an HIV test. These
individuals are also more likely to see a traditional healer for their health care needs, making healers an ideal
group to bridge the health care utilization divide.
 To reach people who otherwise may avoid testing, our team trained 15 traditional healers to conduct HIV
counseling and testing in their own indumbas – a hut or room by their home where they provide care to their
patients (R34MH122259-01, PI Audet). Over six-months, with no advertisement or community events, healers
offered HIV counseling and testing to 463 individuals who visited them for unrelated services. Fifty-four (11.7%)
self-reported a positive HIV status. Of the 409 eligible participants, 316 (77%) agreed to test, and 20 (6.3%)
tested positive- 95% were linked to HIV care and treatment services.
 In collaboration with the Department of Health and Kukula, the local healer’s organization, we propose to build
on our successful pilot to test an expanded Healer-Initiated HIV Testing and Linkage to Care intervention with
the following testing and linkage to care components. Healers will provide three testing services: (1) Advertise
the availability of free healer-initiated counseling and testing for their clients; (2) Offer partner-based testing
services at their facilities or client homes; and (3) Provide monthly community-based testing outreach activities
at local events (e.g., sporting events, fairs). In addition to testing, healers will support linkage to care and
treatment adherence, offering clients accompaniment to their first clinical appointment, ongoing adherence
support/counseling in person or via WhatsApp, and a nurse/CHW/healer WhatsApp group to facilitate more
technical support if needed. We propose a cluster randomized controlled trial (comparing standard of care (SOC)
testing options vs. SOC + enhanced testing with support of traditional healers) at 42 clinical catchment areas to
evaluate the impact this intervention.
 The Specific Aims of this study are to: (1) Compare rates of HIV testing in healer-initiated HIV counseling
and testing communities vs. control communities via a cluster randomized controlled trial in rural South Africa;
(2) Assess adoption, implementation fidelity and maintenance of healer-initiated HIV testing; and (3) Evaluate
the cost-effectiveness of healer-initiated HIV counseling and testing compared to standard of care. Our team has
a proven record of engaging traditional healers to improve patient outcomes, conducting research to evaluate
and address mistrust in the health system, HIV stigma, and developing interventions to increase HIV testing
uptake. We believe that traditional healers are an untapped resource ...

## Key facts

- **NIH application ID:** 10837467
- **Project number:** 1R01MH135738-01
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** Carolyn Audet
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $705,521
- **Award type:** 1
- **Project period:** 2024-04-01 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10837467

## Citation

> US National Institutes of Health, RePORTER application 10837467, Know your status: A cluster randomized controlled trial comparing healer-initiated HIV counseling and testing to standard of care in rural South Africa (1R01MH135738-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10837467. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*