Impact of medical plurality on care engagement and treatment outcomes among people living with HIV in Limpopo, South Africa

: 1.020_NEP Impact of medical plurality on care engagement and treatment outcomes among people living with HIV in Limpopo, South Africa T. Boyd, M. Wright, O. Badejo, R. Dillingham, C. Santee Ann, N. Mondlane, C. Makhado, M. Meskina, P. Nevhutalu, N. Bulled, T. Masebe, L. Mavhandu, P. Bessong; University of Washington, Seattle, WA, USA, University of Virginia, Charlottesville, VA, USA, University of Venda, Thohoyandou, South Africa, Harvard University, Cambridge, MA, USA Background: Medical plurality, the concurrent existence of multiple medical systems, is particularly important in the South African context. The traditional health sector continues to serve as a significant component of health seeking practices for patients living with HIV, yet collaborations with biomedicine for HIV care remains a challenge. This study utilized an in-depth survey to document the engagement of individuals living with HIV, with alternative health sectors: traditional medicine, herbal medicine, and faith healers. Methods: The participants in the study were both male and female patients living with HIV between the ages of 18 and 65, who had been on ARTs for at least one year. Every participant was a patient at either the Fhulufhelo HIV Clinic or the Thohoyandou Health Center in Limpopo, South Africa. After listening to a brief explanation of the study and its purpose, patients had the option of volunteering to take a survey, which inquired about their adherence to ARTs, engagement with traditional health sectors and their understanding of HIV. Verbal and written consent were obtained from every participant and the survey data from every participant was included in the statistical and thematic analysis. Findings: The analyzed sample (n1⁄4102) consisted of 71.6% female and 28.4%males. 25.2% admitted to ever using herbal medicine. 21.4% admitted to ever using traditional medicine. 32% admitted to engaging with faith healers. 34% of the participants had an unsuppressed viral load (n1⁄435). Of the patients that were unsuppressed, 46.3% of them were among the participants who had ever engaged in any of the alternative sectors. While 22.2% of those unsuppressed had never engaged in these alternative sectors. Interpretation: This research suggests engagement with alternative health care sectors is associated with unsuppressed viral loads. This study is important as it may encourage the development of interventions to support better individual and population health outcomes and collaboration between biomedical providers and traditional healers. One limitation was the relatively small sample size (n1⁄4102), in comparison to the total population of people living with HIV in the Vhembe District of South Africa. Funding: University of Virginia Center for Global Health and NIH MHIRT. Abstract #: 1.021_NEP: 1.021_NEP Surgical repair programs for children with non-critical congenital heart disease in lowand middle-income countries: a scoping review Z.J. Brickman, A.J. Hunter; University of Toronto, Toronto, ON, Canada, McMaster University, Hamilton, ON, Canada Background: Congenital heart disease (CHD), the presence of a clinically significant structural heart defect at birth, has a similar incidence globally. However, the lack of quality health systems, available resources, and established programs makes management of CHD more challenging in lowand middle-income countries (LMICs) compared to high-income countries. This scoping review examines current surgical care programs in LMICs for CHD and the outcomes of individuals with non-critical CHD.