Traditional and faith-based healthcare in the management of psychotic disorders in Africa: in search for synergy.

PURPOSE OF REVIEW: This review summarizes the current literature on the role of traditional and faith-based healthcare in the management of psychotic disorders in Africa. RECENT FINDINGS: In contemporary Africa, individuals with psychosis and traditional and faith healers (TFH) are pluralistic towards their understanding of psychosis and their help-seeking behaviour. Traditional healing is perceived to be helpful to patients with psychotic disorders and their family members and may have a positive influence on the course of psychosis in some selected individuals. Studies show that potentially harmful practices are commonly used by African TFH, but that these are associated with a lack of resources and are susceptible to training. Although various TFH and biomedical practitioners are open to collaboration, the many identified obstacles hinder actual partnerships. However, the few studies that have been conducted on collaborative care for patients with psychotic disorders on the continent, show positive outcomes. SUMMARY: Rather than harmonizing the two healing paradigms, synergistic collaboration between traditional/faith-based and biomedical mental healthcare in the management of individuals with psychosis seems to be possible within certain limits. Synergistic collaboration is more culturally syntonic and may actually contribute to bridging the treatment gap for mental disorders in present-day Africa.

The Dual Burden of HIV Infection and First-Episode Psychosis in Africa: A Systematic Review and Meta-Analysis.

ABSTRACT: A systematic review and meta-analysis was conducted to synthesize data on HIV prevalence in individuals with first-episode psychosis (FEP) and to provide an overview of the association of HIV with clinical variables of FEP. Electronic databases were searched for quantitative studies published from January 1986 to November 2019. Meta-analyses were undertaken to calculate the pooled HIV/FEP proportion based on random effects modeling with inverse variance method. Seven HIV/FEP studies from sub-Sahara Africa (SSA) met inclusion criteria. The prevalence of HIV in FEP ranged from 24% to 40%, and FEP in people living with HIV (PLWHIV) ranged from 17% to 29%. The pooled proportion of HIV in FEP was 26% (95% confidence interval [CI], 10%-43%), with significant heterogeneity (n = 3, I2 = 89%, p < 0.01), and of FEP in PLWHIV was 23% (95% CI, 15%-32%), without significant heterogeneity (n = 3, I2 = 0%, p = 0.43). There are concerning levels of HIV and FEP comorbidity in SSA, necessitating an integrated health care service.